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First name
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ACT
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SA
TAS
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Postcode
Email Address
Phone Number
Gender Identity
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Female
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Prefer not to disclose
Who would you prefer to meet with?
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Male mentor only
Female mentor only
Either male or female mentor
Would prefer a male mentor, but would be happy with a female mentor if needed
Would prefer a female mentor, but would be happy with a male mentor if needed
Preferred form of contact
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Phone
SMS
Email
Phone or SMS
Email or Phone
Email or SMS
Any
How would you prefer to meet?
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Online only
In person only
Either in person or online
Communication Considerations (if applicable)
e.g. text before calling, only contact after 5pm.
What help do you need from a Money Mentor?
How did you hear about CAP?
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Searched and found help myself
Family or friend
Church-based program
Healthcare professional (Dr, psychologist, nurse, etc.)
Financial counsellor
Community service organisation (legal, Centrelink, emergency relief, etc.)
Other
Meeting considerations
I am able to travel to meet a Money Mentor (usually within 30 minutes)
I am able to meet with a Money Mentor in my home.
I require a translator.
I will have a support worker with me.
Other Requirements:
Submission
On the submission of this form, I am confirming that:
I am submitting this for myself, and not on behalf of someone else.
I give permission for CAP to share my contact details with a Money Mentor.
I have read and agree to
CAP's Privacy Policy
.
Contact Information