Bridge the Gap Referral - RMHC VIC & TAS

Referral for Bridge the Gap Support

Referral Details

Referral Date(Required)

Student Name(Required)

First Last

Student Date of Birth(Required)

Current Year Level(Required)

Parent / Guardian Contact(Required)

First Last

Contact Number(Required)

Contact Email(Required)

Enter Email Confirm Email

Best Time to Contact You(Required)

Diagnosis(Required)

Treatment Hospital(Required)

Expected Discharge(Required)

Expected 'Gap' Time away from School(Required)

Name of Referrer(Required)

Referrer's Contact Number(Required)

Referrer's Contact Email(Required)

Enter Email Confirm Email

Outline of Assistance Required

Literacy:

Maths:

Other subject areas (if Secondary) / other information:

CAPTCHA

Make a Difference for Families & Children

Parents don’t know when their children will need medical help. But they should know they can always access the care they need. And with your help, we can support them all throughout their journey.

Referral for Bridge the Gap Support

Referral Details

Outline of Assistance Required

Make a Difference for Families & Children

It's your final chance to give. EOFY ends at midnight!

Families with sick kids still need your help.