Department of Human Services

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Privacy Statement

DHS will use information collected from this form for the purpose of evaluating your accommodation enquiry. You are not lawfully required to submit a response. In accordance with DHS’ Privacy Policy, DHS undertakes to treat any personal information provided by you as confidential and only for the purposes indicated above. Any information submitted will only be retained for such time as necessary to carry out the purposes for which the information is collected or as required by law. Email addresses and any other contact details you provide will not be provided to a third party or added to a mailing list without your consent. For further information please contact dhsasintake@sa.gov.au.

Referrer
Applicant information
Date of Birth *
For example, External support coordinator, Appointed Guardian
Funding
Funding program *

Page last updated : 09 Feb 2022

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