Referral to Care's Financial Counselling Program

Care Financial Counselling provides support to people in the ACT who are struggling with debt, including energy bills. When we receive your form our intake team will call you within two (2) business days. Please note, we will call from a private number and will not leave a message unless you indicate it is okay for us to do so. If you prefer to call Care Financial Counselling directly, please call our helpline on 1800 007 007 (9am-4.30pm Monday to Friday).

When you submit a contact form on our website, you agree to provide this information to Care Inc. to carry out our services. This information will not be used or sold for any other purpose. For more information on Care’s privacy policy visit https://www.carefcs.org/privacy-policy

Referee

Date

Referring service *

Worker Contact Details

Name/Position of Worker

Consent for referral given? *

Client Details

Name *

Date of birth

Country of birth

Email Address

Phone

Contact rule *

Permission to callPermission to leave a messagePermission to send an emailPermission to send an SMS

Address

Is an Interpreter required

Yes No

Language

Does the client identify as

Aboriginal Torres Strait IslanderBoth

Does the client identify as having a disability

YesNo

Source of Income

WagesCentrelinkSelf EmployedNo income

Housing Type

Housing ACTPrivate RenterCommunity HousingHome-Owner Occupier

Energy Provider

Assistance Required

If you are at risk of disconnection then you should also contact your energy provider's hardship team.

Brief background - Client wants support with

Energy billsCredit or debt issues

Further Information

Care referral reCAPTCHA *

The Home Energy Tune-Up program has been funded by the ACT Government