Please enable JavaScript in your browser to complete this form.Full Name *FirstLastDate of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *MaleFemaleHouse Number and Street Name *Suburb *Postcode *Contact Phone Number *Email *Date of Arrival *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Passport Number *After submission a copy of your passport will be requestedAustralian Visa Type *Student VisaTemporary Employment VisaTourist VisaOtherCountry of Birth *Marital Status *SingleMarriedDe-facto / PartnerOtherNumber of Dependents *Employment Status *Lost full time job due to COVID 19Lost part time job due to COVID 19Job hours reduced due to COVID 19Partner lost full time job due to COVID 19Partner lost part time job due to COVID 19Partner's job hours reduced due to COVID 19Unemployed because can't find employmentPartner unemployed because he/she can't find employmentEducational Institution (only applicable to International Students)) *Reason/s for ER Assistance (200 word) - Provide a brief description/reasons for your ER situation *Type of Assistance Required *Payment of Rental ArrearsPayment of Overdue Utilities/BillsColes Vouchers (for purchase of food/groceries)Others (please specify in below field)Please specify if other type of assistance required *If ER assistance is to be provided for Payment of Utilities or Rental Arrears supporting documentation such as a copy of the overdue bill or proof of rental arrears should be uploaded below. The latter should include banking details (Account Name, BSB and Account Number of the real estate agent/owner).Upload copy of Utilities/Bills or Rental Arrears (if applicable) * Click or drag files to this area to upload. You can upload up to 2 files. Max File Size 3mb. Allowed Formats: .jpg, .jpeg, .doc, .docx, .pdf, .pngDeclaration I hereby declare that the information I have provided in the form is true & correct to the best of my knowledge and belief. If the information provided is found to be untrue, I accept that MSCWA can take relevant action to forfeit the emergency relief they have provided.Declaration Acceptance *I accept all the terms in the above declarationNotes: MSCWA will assist an applicant for Emergency Relief (ER) ONLY once every six months. MSC's ER program does not operate after 3pm on Thursday until 8:30am on Monday. So most people who submitted ER forms after 3pm on Thursday will be contacted on Tuesday or Wednesday. If all relevant documentation is not provided with the online request for ER, the processing will be further delayed.*Employment - If you are interested in seeking employment, please fill out the Job Skills Centre Form.**Housing - We are seeking to head lease properties and sublease it to students who are prepared to share it and abide by the house rules that will apply. ATR applicants wishing to share a house (3-4 individuals) are invited to send an email to housing@mscwa.com.au listing the names of those who wish to share a house, their preferred suburbs and their contact details.Captcha - Prove you are not a bot * = EmailSubmit
