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Your Message

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Online Application Form

About You

Additional Contact Person

Support Person

Your Request

How Can We Help?

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

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 Torres Strait Islander?

Yes

Unsure

How did you find out about LinkUp Victoria?

Were you:

Adopted

Fostered

Placed in Children's Home

Other

Please provide any more details

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

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.

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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
Our Work
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.