Warm Referral Form - Law Access Western Australia

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Refer a Matter

Warm Referral Form

Step 1 of 9

11%

Please read the information below before you start.
Law Access does not provide legal services

Law Access does not provide legal advice or representation.

Law Access will not act as the lawyer for the person you are referring.

The person you are referring remains responsible for meeting any limitation dates or important dates in their matter and attending any hearings.

If they are eligible, Law Access will try to find a lawyer willing to help without charging their usual fees.

If we find a lawyer or law firm willing to help, the person you are referring is responsible for negotiating the terms of engagement with the lawyer or firm.
Declaration(Required)
- I UNDERSTAND AND AGREE. I WANT TO START MY WARM REFERRAL.

You can complete the application form online, or you can download the PDF and complete it digitally or by hand (after printing the PDF) and then email or post it back to us.(Required)
- Complete the online form
- Download the PDF
Authority Form
We will need our authority form completed by the person you are referring. Download the authority form here and arrange for the person to sign it. Please then upload the signed form in the section below.

If it is intended that we contact you about this matter, please ensure the nominated contact section is completed on the authority form.

If you are unable to have the person complete the form, Law Access will contact them directly.
Upload Completed Authority Here
Max. file size: 10 MB.
- I am unable to arrange a completed authority form at this time
Information and Documents
You will be asked to upload documents as part of your application.
You should scan or save the documents we are likely to need before you start.

The types of documents we may request are:
- Evidence that their household is low income and low assets, such as bank statements, pay-slips, Centrelink Income Statements.
- Any documents relevant to their legal issue including court documents and decisions, letters or emails about their dispute, legal advice they’ve received and anything else that we would need to understand their legal issue.
Family Law - property: you will need the completed Property Steps Referral Form.
Download the PDF form

Your Contact Details (Referrer)
Referrer Name
Organisation / Firm Name
Email Address
Phone number
Postcode
State
If you have prepared a summary of the matter and details of referral please attach it here. If any of the upcoming questions are answered in the document, you can just tick or write "See attached".
Drop files here or

Max. file size: 10 MB.
What assistance have you provided and will you provide to this person?
- No assistance
- We have previously provided them assistance but this has finished
- We are currently providing them assistance
- We will be providing them assistance in the future
- See attached
Was/is your assistance for the same legal issue that you refer them?
- Same issue
- Different issue
- See attached
- Other
Please specify
Was your assistance legal assistance?
- Yes
- No
- See attached
More details regarding last question (optional)
We apply a means test to all applicants unless it is a matter of significant public interest. Is the applicant of low/no income (including financial support from others)? Please tick all that apply.
- Yes they are low/no income
- No, they are not low/no income
- There is significant public interest in this matter
- See attached
- Unsure
Do you know what assets they own?
- Yes
- See attached
- Unsure
Assets include housing, cars, money in bank accounts, shares and anything else of any value.
Please list assets, their value and any amount they owe for the asset (e.g. a mortgage).
If you have any of the below information for the person you are referring, please attach it here:
- Bank statements for all accounts for the last three months
- A recent Centrelink income statement
- A recent payslip
If not, please make the person aware we may request this information from them.
Drop files here or

Max. file size: 10 MB.
If you are a legal service, do you consider there is merit in this person receiving pro bono assistance?
- We are not a legal service
- We consider there to be merit
- We have not assessed merit
- See attached
- Other
Please specify
If you have provided any legal advice on this issue, please attach here where possible (e.g. any letters to the person or any note/ summary of legal advice if not already attached).
Drop files here or

Max. file size: 10 MB.

Person Needing Legal Assistance
Title
Please specify their preferred title
First Name(s)
Middle Name(s)
Last Name
Are they or have they been known by any other name(s)?
- Yes
- No
- See attached
- Unsure
Please list their other name(s)
Preferred phone number
Secondary phone number
Email Address
Date of Birth
What is the person's gender?
- Male
- Female
- Non-binary
- See attached
- Unsure
- Other
Please specify
What are the person's preferred pronouns? (optional)
- He/Him
- She/Her
- They/Them
- See attached
- Unsure
- Other
Please specify
Does the person identify as LGBTQIA+?
- Yes
- No
- See attached
- Unsure
Does the person find it hard to read or write (in English)?
- No
- They find it hard to read
- They find it hard to write
- Unsure
- See attached
Tick all that apply.

Addresses
Is the person staying at a temporary address?
- Yes
- No
- See attached
- Unsure
This includes prison/detention, hospital or a refuge.
What is the name and type of the place they are temporarily residing in?
For example Acacia Prison, Jones Street Refuge, or their mum’s house.
What is their current temporary address?
Street Address
Address Line 2
Suburb
State
Postcode
What is the person's usual home address?
Street Address
Address Line 2
Suburb
State
Postcode
Is the person's postal address the same as their home address?
- Yes
- No
- See attached
- Unsure
What is the person's postal address?
Street Address
Address Line 2
Suburb
State
Postcode
Is the person homeless or at serious risk of homelessness?
- Yes
- No
- See attached
- Unsure
What are the person's family circumstances (e.g. do they live with a partner, do they have dependents)?

Culture and Language
Does the person identify as Aboriginal or Torres Strait Islander?
- Aboriginal
- Torres Strait Islander
- Neither
- See attached
- Unsure
Tick all that apply.
What is the main language the person speaks at home?
- English
- See attached
- Unsure
- Other
Please specify
Does the person feel confident speaking about their legal issue in English?
- Yes
- No
- See attached
- Unsure
Would an interpreter help them to understand?
- Yes
- No
- See attached
- Unsure
We can arrange an interpreter if needed.
What is their preferred language?
In which country was the person born?
Country
When did they arrive in Australia?

Health and Disability
Does the person have any disabilities?
- Yes
- No
- See attached
- Unsure
A disability may be a cognitive impairment such as an intellectual disability, an acquired brain injury or a physical disability.
Please list their disabilities below
Does the person have any diagnosed mental health issues?
- Yes
- No
- See attached
- Unsure
These include diagnosed psychiatric or psychological illnesses.
Please list their mental health issues below
Does the person have any other serious health issues?
- Yes
- No
- See attached
- Unsure
Please list their serious health issues below

Family Violence and Restraining Orders
Has the person you are referring experienced family violence?
- Yes
- No
- See attached
- Unsure
Family violence is behaviour towards a family member that is violent, threatening or controlling, or causes the family member to be fearful.
Has the person experienced family violence from the other party in their legal issue?
- Yes
- No
- See attached
- Unsure
Has the person recently experienced family violence from any other person?
- Yes
- No
- See attached
- Unsure
Has the person you are referring ever had a restraining order against the other party in their legal issue?
- Yes
- No
- See attached
- Unsure
Where the person you are referring is the protected person.
When was the restraining order?
- They have a restraining order now
- There was a restraining order in the past
- See attached
- Unsure
Tick all that apply.
What type of restraining order does the person have?
- Family Violence Restraining Order
- Violence Restraining Order
- Misconduct Restraining Order
- Conduct Agreement Order
- See Attachment
- Unsure
- Other
Tick all that apply.
Please specify
When did the restraining order end?
What type of restraining order(s) did the person have?
- Family Violence Restraining Order
- Violence Restraining Order
- Misconduct Restraining Order
- Conduct Agreement Order
- See Attachment
- Unsure
- Other
Tick all that apply.
Please specify
Has the other party ever had a restraining order against the person you are referring?
- Yes
- No
- See attached
- Unsure
Where the person you are referring is the person bound.
When was the restraining order?
- They have a restraining order now
- There was a restraining order in the past
- See attached
- Unsure
Tick all that apply.
What type of restraining order do they have?
- Family Violence Restraining Order
- Violence Restraining Order
- Misconduct Restraining Order
- Conduct Agreement Order
- See Attachment
- Unsure
- Other
Tick all that apply.
Please specify
When did the restraining order end?
What type of restraining order(s) did they have?
- Family Violence Restraining Order
- Violence Restraining Order
- Misconduct Restraining Order
- Conduct Agreement Order
- See Attachment
- Unsure
- Other
Tick all that apply.
Please specify

About the Person's Legal Issue
What does the person need legal help with?
- Criminal Law
- Family Law - property
- Immigration Law
- Employment Law
- Criminal Injuries Compensation
- A Deceased Estate
- See Attached
- Unsure
- Other
Please specify what they need legal help with
What are the details of the other party or parties in the person’s matter? Tell us all the details you know including full names and dates of birth, company details etc.
What are the names of the lawyer and law firm/organisation assisting the other party or parties?
What is happening in the legal matter at the moment?
What has happened to get to this point (what is the history of the matter)?
What would the person like to happen in their legal matter?
Are there any hearing dates coming up?
- Yes
- No
- See attached
- Unsure
Including Courts, Tribunals, commissions and other bodies and for any type of hearing, mediation, conciliation.
When is it?
Which Court/Tribunal?
What type of hearing?
Are there any other deadlines or important dates coming up (including limitation dates, filing dates and any other important dates)?
- Yes
- No
- See attached
- Unsure
When is it?
What type of important date is it?
Please attach any documents relevant to the matter
Relevant documents include:
- Court/Tribunal documents or decisions.
- Relevant letters or emails.
- Any legal advice they have received.
- Other documents that would help us understand their legal issue.
If you do not have these documents, please ensure the person is aware we may request these documents from them.
Family Law - Property Steps Referrals: upload the Referral Form.
Drop files here or

Max. file size: 10 MB.
How did you hear about Law Access?
Please specify

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Law Access acknowledges the traditional custodians throughout Western Australia and their continuing connection to the land, waters and community. We pay our respects to all members of the Aboriginal communities and their cultures, and to Elders both past and present.

Please Note: The information on our website does not constitute legal advice. There is no guarantee we will be able to organise pro bono assistance for you, even if you are eligible. Law Access Ltd does not, by referring an applicant or a matter to a particular legal practitioner, law firm, community legal centre or other service, warrant the services of that practitioner, firm, centre or service.

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