Student Internet Form - Anglicare Victoria

Multi–Language Enquiry Form

This enquiry form is provided for those who require a translated version.

Please utilise the Accessibility & Language function at the bottom of the screen to select a language of preference.

Enquiry

Call us on 1800 954 610 (10am – 6pm AEDT Monday to Friday, excluding Victorian Public Holidays) or complete the form below and a member of the team will get back to you.

First name *

Last name*

Address *
Please check that the address you have entered is correct.

Contact number * (no spaces)

Email address

Preferred contact method *
If you select phone, please note all returned calls will come from 03 8583 2122.

Preferred contact time
Day and time preference

Do you require interpreter services?

Please specify your preferred language

Do you agree to share your address as part of this check for eligibility?* By ticking the box you agree to share your address with nbn® to see if you are currently connected to a national broadband service and check the technology type in your area. If the home is eligible your address information is collected by nbn® and provided to the Australian Government for their own reporting purposes. All information is obtained in line with Anglicare Victoria’s Privacy Policy. Do you also confirm that the information provided is true and correct?