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The Leaving Violence Program is not a crisis service. If you're in immediate danger, call 000.

Let’s start by confirming the eligibility of the client you are representing

About your client

*Is your client 18 years old or older?
*Has your client been, or is currently being harmed in some way by a current or former intimate partner ?
*Is your client experiencing issues with their money or finances ?

Their living circumstances

*Has your client changed, or are they planning to change, where they live because of their experience of intimate partner violence ?

Please select the option that applies to them.
*Does your client reside in Australia and hold one of the following:

Please confirm

*Has your client received financial support from the Leaving Violence Program, the Escaping Violence Payment (EVP) trial, the Temporary Visa Holders Experiencing Violence Pilot (TVP), or Regional Trials within the past 12 months?

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Help us refine and improve the experience for Referral Agencies

To submit a complaint, compliment or provide general feedback about your service experience as a referral agency, please use our Referral Agency Feedback Form.