Social Work and Counselling Case Intake Form (Referral)

This form is for Referral Personnel to apply on behalf of someone else.

If you are not applying on behalf of someone, please fill up this form instead.

As per NIRC/FIN/Passport
Personal Data Protection Act (PDPA) clause: In compliance with the Personal Data Protection Act, Presbyterian Community Services is committed to protecting personal data we have collected from you. By providing your personal details in the process of this application, you are consenting for Presbyterian Community Services to use your personal data or disclose your personal data to third parties where necessary for the following purposes:

  1. assessing and evaluating your application for financial assistance,
  2. verifying your identity and accuracy of your personal details and other information provided,
  3. administration of the financial assistance,
  4. contacting you about and involving you in our activities,
  5. research and evaluation, and
  6. making a referral to another agency.