First Name *

Last Name *

Phone Number

Email Address

Your Message

Home/Application Form/Apply Online

Online Client Application Form

About You

Additional Contact Person

About You

Salutation

First Name

Middle Name

Last Name

Did you have a different name at birth?

Yes

Birth Name

Do you have other names?

(e.g. maiden, nickname, alias, etc.)

Yes

Other Names

Current Address

Address Line 1

Address Line 2 (if applicable)

Suburb

Post Code

State

Home Phone Number

Business Phone Number

Mobile Phone Number

Email Address

Date of Birth

Day

Month

Year

Place of Birth

Please include a state

Are you Aboriginal?

Yes

Unsure

Are you Torress Strait Islander?

Yes

Unsure

How did you find out about LinkUp Victoria?

Were you:

Adopted

Fostered

State Ward

Institutionalised

Other

What year, or how old were you?

Where were you placed?

Additional Contact Person

Who else can we contact if we are unable to contact you?

Name

First Name

Last Name

Current Address

Address Line 1

Address Line 2 (if applicable)

Suburb

Post Code

State

Phone Number

Support Person

Do you have a support person working with you from another service?

Yes

Name

First Name

Last Name

Phone Number

Service/Organisation

Your Request

What are you searching for?

I am searching for information about myself

I am searching for family

Do you have your full Birth Certificate?

Yes

Adopted or Original

Adopted

Original

Please upload a copy of your birth certificate

Please note that you can take a photo directly from your phone

Do you have your adoption or state ward file?

Yes

Adoption file or Ward file?

Adoption file

Ward file

Please upload your adoption or state ward file

Do you have any other information about your removal?

Yes

Do you have any other information about your family?

Yes

Are any agencies or organisations assisting you with your search?

Yes

Please provide details.

Who are you searching for?

(e.g. mum, dad, brother, sister)

First Name

Last Name

Other Names/Aliases

Date or Year of Birth

Place of Birth

Please include a State

Is this person Aboriginal?

Yes

Is this person a Torres Strait Islander?

Yes

Was this person:

Adopted

Fostered

State Ward

Institutionalised

Don't know

Do you have any documents about this person?

Yes

Please provide copies

What year was this person separated from the family?

Where were they placed?

Please provide as much information as you can about who you are searching for, e.g. names of relatives, birth dates, key places (where born, where taken from, where taken to), parents names, brothers and sisters, etc.

About Family

Mother

Mother's Name

First Name

Last Name

Other Names/Aliases

Date or Year of Birth

Day

Month

Year

Place of Birth

Please include a State

Is your mother Aboriginal?

Yes

Is your mother a Torres Strait Islander?

Yes

Father

Mother's Name

First Name

Last Name

Other Names/Aliases

Date or Year of Birth

Day

Month

Year

Place of Birth

Please include a State

Is your mother Aboriginal?

Yes

Is your mother a Torres Strait Islander?

Yes

How Can We Help?

How would you like Link-Up Victoria to assist you? Is there any other information that will assist with the search? Please provide as much information as you can.

Permissions

Would you like to be included on the Link-Up Victoria mailing list?

Yes

Do you consent to your photographs being used for promotional purposes? (eg. newsletter, website, etc.)?

Yes

The “Link-Up National Name Index” improves family tracing services through interstate Link-Up services. Do you consent to your name, date of birth and place of birth being registered on this database?

Yes

If we need to refer you to another service specific to your needs, do you consent to Link-Up Victoria sharing your personal details with other services, agencies and organisations?

Yes

If there are any places that you DO NOT want your information shared with, please provide details.

Link-Up Victoria seeks to continually improve the service we provide to our clients. One of the ways we do this is to organise an independent review of our service. Do you consent to your file being included in our reviews?

Yes

Please Note: Copies of three forms of current personal identification needs to be attached with this form, stating your current address and preferably including a photo and/or signature.

Please attach three forms of current personal identification that state your current address and preferably include a photo and/or signature.

I confirm that I have read and understand the Link-Up Victoria Client Rights and Responsibilities booklet advising me of my rights and responsibilities if I become a client. I also confirm that I have received a pack with information about the services provided by Link-Up Victoria and information about privacy and use of my personal information.

Please sign *

I give permission to Link-Up Victoria staff to access any information held by other services on my behalf to assist in the research about my natural family, including copies of my files. I understand that files may be held in government departments, welfare agencies, State and/or Commonwealth archives, church organisations, libraries or other places. I give permission for Link-Up Victoria to access any relevant Birth, Death or Marriage certificates that might be held by any Registry office nation-wide. I understand that Link-Up Victoria may need to contact interstate Link-Up services and agree for any Link-Up service to undertake searches on my behalf. For clients who are eligible for a service from the Koorie Family History Service, Koorie Heritage Trust: I give permission for Link-Up Victoria to obtain a copy of my family tree from the Koorie Family History Service, Koorie Heritage Trust. I understand that Link-Up Victoria will keep a copy of my family tree on my file at Link-Up Victoria.

Please Sign

14%

Connect with us

Our Services
About
Testimonials
News and Events
Resources
Bringing Them Home Workers
Submit an Application

Have any questions?

Get in touch to find out how we can assist you with your journey.

General Enquiries

03 7002 3700

Link-Up Victoria

1800 OUR MOB: 1800 687 662

Link-Up Victoria
340 Bell Street, Preston, VIC 3072
PO Box 191 Preston Post Office, High Street, Preston VIC 3072

Our Services
About
Testimonials
News and Events
Resources
Bringing Them Home Workers
Submit an Application

Aboriginal and Torres Strait Islander people should be aware that this website may contain images, voices or names of deceased persons in photographs, film, audio recordings or printed material.