North Australian Aboriginal Family Legal Service
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NAAFLS Leaving Violence Program (LVP) Referral Form

Please complete the NAAFLS Leaving Violence Program (LVP) Trial Referral Form below. Once submitted, one of our NAAFLS Leaving Violence Program (LVP) Intake Officers will contact you within two business days to complete the application intake.

If you would prefer to complete the referral form by phone or in person, please call NAAFLS on 1800 041 998 and ask to speak to the Leaving Violence Program Intake Team.

Name
Ethnicity
Identification
Drag & Drop Files, Choose Files to Upload You can upload up to 5 files.
Required: Please upload identification documents to verify your identity. Examples include: government-issued photo identification (e.g. Driver Licence, Proof of Age Card or Passport), Centrelink statement and/or concession card, Medicare card, financial institution (bank) statement, or police statutory declaration. If you are unable to provide identification at the time of referral, please select the option above and a member of the NAAFLS Leaving Violence Program Intake Team will contact you to discuss alternative arrangements.
Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.
Optional: Upload supporting documentation that identifies the applicant has left, or is planning to leave, an intimate partner violence relationship (e.g. Domestic Violence Orders, police reports, supporting organisation/agency documentation, community and/or family support letters, DV safety plans, CRAT documentation, or other relevant evidence).