MOD Y - Unreasonable to Live at Home Instructions
This form contains 182 fields organized into 46 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Attempts to Sort Out Differences | ||
| Person or Organization 1 Name | Text |
Please provide the name of the first person or organization that you or your parent(s)/guardian(s) consulted for help in resolving differences. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| No (Question 26) | Checkbox |
Check this box if you and/or your parent(s)/guardian(s) have NOT tried to sort out your differences. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes (Question 26) | Checkbox |
Check this box if you and/or your parent(s)/guardian(s) HAVE tried to sort out your differences. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Bank Account Details Change Options | ||
| No | Checkbox |
Check this box if you do not need to change your bank account details.
|
| Yes | Checkbox |
Check this box if you need to change your bank account details and will provide the new details below.
|
| Bank Account Change Details | Text |
Provide the necessary details if you need to change your bank account information.
|
| Change in Relationship with Parent/Guardian | ||
| Person or Organisation Name 1 | Text |
Provide the name of the first person or organisation that you and/or your parent(s)/guardian(s) sought help from to resolve differences. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| No | Checkbox |
Check this box if your relationship with your parent(s)/guardian(s) has not changed since you left home. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if your relationship with your parent(s)/guardian(s) has changed since you left home. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Improved | Checkbox |
Check this box if your relationship with your parent(s)/guardian(s) has improved since you left home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Deteriorated | Checkbox |
Check this box if your relationship with your parent(s)/guardian(s) has deteriorated since you left home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Conditions for Returning Home | ||
| No conditions apply | Checkbox |
Check this box if no conditions apply for returning home to live with your parent(s)/guardian(s). Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Conditions apply | Checkbox |
Check this box if there are conditions that apply for returning home to live with your parent(s)/guardian(s). Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Summary of Conditions | Text |
Enter a brief summary of any conditions that apply for returning home to live with your parent(s)/guardian(s). Fill only if 'Conditions apply' is 'Yes'.
Depends on:
Conditions apply
|
| Detailed Conditions | Text |
Provide a detailed explanation of any conditions that apply for returning home to live with your parent(s)/guardian(s). Fill only if 'Conditions apply' is 'Yes'.
Depends on:
Conditions apply
|
| Contact Details | ||
| Phone Number | Text |
Please enter your phone number, including the area code.
|
| Mobile Phone Number | Text |
Please enter your mobile phone number.
|
| Contact with Parent/Guardian Since Leaving Home | ||
| Details Reference | Text |
Enter a reference number or identifier for the contact details provided. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| No | Checkbox |
Check this box if you have not had any contact with your parent(s)/guardian(s) since you left home. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if you have had contact with your parent(s)/guardian(s) since you left home. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Contact Details | Text |
Provide comprehensive details about any contact made with your parent(s)/guardian(s) since leaving home, including the type of contact, how often it occurred, and who initiated it. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Current Accommodation Details | ||
| Refuge/Hostel or People You Live With | Text |
Provide the name of the refuge or hostel, or the name(s) of the people you currently live with. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Current Address | ||
| Address Line 1 | Text |
Please enter the first line of your current address.
|
| Address Line 2 | Text |
Please enter the second line of your current address.
|
| Address Line 3 | Text |
Please enter the third line of your current address, such as your town or city.
|
| Postcode | Text |
Please enter your current address postcode.
|
| Current Living Situation | ||
| Partner (married, registered partner or de facto) | Checkbox |
Check this box if you currently live with a partner who is married, in a registered partnership, or in a de facto relationship.
|
| Friends | Checkbox |
Check this box if you currently live with friends.
|
| In a refuge/hostel | Checkbox |
Check this box if you currently live in a refuge or hostel.
|
| Alone | Checkbox |
Check this box if you currently live by yourself.
|
| DummyCalcQ12 | Text | |
| Other | Checkbox |
Check this box if your current living situation is not covered by the other options and you will provide details.
|
| 12 | Text |
Depends on:
Other
|
| Current Nominee Status | ||
| No | Checkbox |
Check this box if you do not have a current nominee.
|
| Yes | Checkbox |
Check this box if you have a current nominee.
|
| Customer Reference Number | ||
| Customer Reference Number - Part 1 | Text |
Please enter the first part of your customer reference number in this field.
|
| Customer Reference Number - Part 2 | Text |
Please enter the second part of your customer reference number in this field.
|
| Customer Reference Number - Part 3 | Text |
Please enter the third part of your customer reference number in this field.
|
| Customer Reference Number - Part 4 | Text |
Please enter the fourth part of your customer reference number in this field.
|
| DummyCalcQ7 | Text | |
| Date Moved from Parents Home | ||
| Day Moved Out | Date |
Please provide the day you moved out of your parent's home. Fill only if 'No, I do not live with my parents' is 'Yes'.
Depends on:
No, I do not live with my parents
|
| Month Moved Out | Date |
Please provide the month you moved out of your parent's home. Fill only if 'No, I do not live with my parents' is 'Yes'.
Depends on:
No, I do not live with my parents
|
| Year Moved Out | Date |
Please provide the year you moved out of your parent's home. Fill only if 'No, I do not live with my parents' is 'Yes'.
Depends on:
No, I do not live with my parents
|
| Date of Birth | ||
| Day of Birth | Date |
Please enter the day of your birth.
|
| Month of Birth | Date |
Please enter the month of your birth.
|
| Year of Birth | Date |
Please enter the year of your birth.
|
| Date of Last Contact with Other Parent | ||
| Day of Last Contact | Text |
Please provide the day of the last contact with your other parent. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Month of Last Contact | Text |
Please provide the month of the last contact with your other parent. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Year of Last Contact | Text |
Please provide the year of the last contact with your other parent. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Declaration | ||
| I have read, understood and agree to the above. | Checkbox |
Check this box if you have read, understood, and agree to the entire declaration, including confirming the information provided is complete and correct, and understanding Services Australia's right to make enquiries and the seriousness of providing false information.
|
| Declaration Date Day | Text |
Enter the day of the month when this declaration was made.
|
| Declaration Date Month | Text |
Enter the month of the year when this declaration was made.
|
| Declaration Date Year | Number |
Enter the year when this declaration was made.
|
| Declarant Signature | Text |
Provide your signature for this declaration.
|
| Desire to Return Home with Parent/Guardian | ||
| No | Checkbox |
Check this box if you do not want to return home to live with your parent(s)/guardian(s). Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if you want to return home to live with your parent(s)/guardian(s). Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Return Home Comments and Additional Information | Text |
Provide comments regarding your desire to return home, nominate which parent/guardian you would like to live with if applicable, or offer any other information relevant to your living arrangements. Fill only if 'No', 'Yes' is 'Yes' for any.
Depends on:
No, Yes
|
| Details of Parent Last Lived With | ||
| Parent's Name | Text |
Enter the full name of the parent with whom you last lived. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Parent's Street Address | Text |
Provide the street address of the parent with whom you last lived. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Parent's City/Town | Text |
Enter the city or town of the parent with whom you last lived. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Parent's Postcode | Text |
Enter the postcode of the parent with whom you last lived. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Parent's Contact Phone Number | Text |
Provide the contact phone number, including the area code, of the parent with whom you last lived. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Mother | Checkbox |
Check this box if the parent you last lived with, whose details are provided in section 15, is your mother. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Father | Checkbox |
Check this box if the parent you last lived with, whose details are provided in section 15, is your father. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Guardian | Checkbox |
Check this box if the person you last lived with, whose details are provided in section 15, is your guardian. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Expected Duration of Current Arrangement | ||
| Emergency/short term | Checkbox |
Check this box if you expect to live in this arrangement for an emergency or short term. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Long term | Checkbox |
Check this box if you expect to live in this arrangement for a long term. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Not sure | Checkbox |
Check this box if you are not sure how long you expect to live in this arrangement. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| First Occasion Leaving and Returning Home | ||
| Day Left Home | Text |
Provide the day of the month you first left your parent's home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Month Left Home | Text |
Provide the month you first left your parent's home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Year Left Home | Number |
Provide the year you first left your parent's home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Day Returned Home | Text |
Provide the day of the month you first returned home to live with your parents. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Month Returned Home | Text |
Provide the month you first returned home to live with your parents. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Year Returned Home | Number |
Provide the year you first returned home to live with your parents. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| First Person/Organisation Contacted for Help | ||
| First Person/Organisation Contacted | Text |
Enter the name of the first person or organisation that you or your parent(s)/guardian(s) contacted for help to sort out differences. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| No | Checkbox |
Check this box if going to this person or organisation has not helped improve your relationship. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if going to this person or organisation has helped improve your relationship. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| General | ||
| Instructions | Button | |
| Instructions | Button | |
| Q7GoToQ9 | Button | |
| Q9GoToQ37 | Button | |
| Q12GoToQ14 | Button | |
| Q15.Address1 | Text | |
| Q15.Address2 | Text | |
| Q17GoToQ20 | Button | |
| Q26GoToQ28 | Button | |
| Q27.GoToQ29 | Button | |
| Q31GoToQ33 | Button | |
| Q32.GoToQ34 | Button | |
| Clear button | Button | |
| Guardian Details | ||
| No | Checkbox |
Check this box if no one other than your parent(s) is responsible for looking after you. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if someone other than your parent(s) is responsible for looking after you. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Guardian Details Indicator | Text |
Enter any brief indicator or reference related to providing guardian details below. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Guardian's Name | Text |
Enter the full name of the guardian. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Guardian's Address Line 1 | Text |
Enter the first line of the guardian's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Guardian's Address Line 2 | Text |
Enter the second line of the guardian's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Guardian's Address Line 3 | Text |
Enter the third line of the guardian's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Guardian's Postcode | Text |
Enter the guardian's postal code. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Guardian's Phone Number | Text |
Enter the guardian's contact phone number, including the area code. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Duration of Guardianship | Text |
Enter the duration for which the guardian has been looking after you, for example, in days, months, or years. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Impact of Incidents Leading to Leaving Home | ||
| Impact of Incidents | Text |
Provide a detailed explanation of how you were affected by the incidents or problems that led to you leaving home. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Living Arrangement with Other Parent | ||
| No | Checkbox |
Check this box if your other parent will not allow you to live with them. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if your other parent will allow you to live with them. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Other Parent Living Arrangement Details | Text |
Please provide details regarding whether your other parent will allow you to live with them. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Living with Parents Status | ||
| No, I do not live with my parents | Checkbox |
Check this box if you do not live with your parent(s).
|
| Yes, I live with my parents | Checkbox |
Check this box if you live with your parent(s).
|
| Living with Parents Status Code | Text |
Enter the specific code or instruction reference related to living with parents if 'Yes' is selected.
|
| Name | ||
| Mr | Checkbox |
Check this box if your title is Mr.
|
| Mrs | Checkbox |
Check this box if your title is Mrs.
|
| Miss | Checkbox |
Check this box if your title is Miss.
|
| Ms | Checkbox |
Check this box if your title is Ms.
|
| Mx | Checkbox |
Check this box if your title is Mx.
|
| Other Title | Text |
Please provide your title or prefix if it is not listed among the options Mr, Mrs, Miss, Ms, or Mx. Fill only if 'Mx' is 'Yes'.
Depends on:
Mx
|
| Family Name | Text |
Please provide your family name.
|
| First Given Name | Text |
Please provide your first given name.
|
| Second Given Name | Text |
Please provide your second given name.
|
| Nominee Arrangement Continuation | ||
| No | Checkbox |
Check this box if you do not want the nominee arrangement to continue. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you want the nominee arrangement to continue. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Contact for Family Circumstances | ||
| No | Checkbox |
Check this box if there is no other person who can tell us about your family circumstances. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if there is another person who can tell us about your family circumstances. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Details of Other Contact | Text |
Provide additional information or specific details about the other contact who can speak about your family circumstances. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Person's Name | Text |
Enter the full name of the contact person. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 1 | Text |
Enter the first line of the contact person's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 2 | Text |
Enter the second line of the contact person's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Address Line 3 | Text |
Enter the third line of the contact person's address, typically the city or town. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Postcode | Text |
Enter the postcode for the contact person's address. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Contact Phone Number | Text |
Enter the contact person's full phone number, including the area code. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Information for Unreasonable to Live at Home Decision | ||
| No | Checkbox |
Check this box if you have no additional information to provide that would help decide if it is unreasonable for you to live at home with your parent(s)/guardian(s). Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if you have additional information to provide that would help decide if it is unreasonable for you to live at home with your parent(s)/guardian(s). Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Details Reference | Text |
Provide a brief note or reference for the additional details provided regarding why it is unreasonable to live at home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Information Details | Text |
Provide any other information, documents, or reports that will help determine if it is unreasonable for you to live at home with your parent(s)/guardian(s). Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Other Parent's Details | ||
| Q16.Name | Text |
Depends on:
No
|
| Q16.Address1 | Text |
Depends on:
No
|
| Q16.Address2 | Text |
Depends on:
No
|
| Q16.Address3 | Text |
Depends on:
No
|
| Postcode | Text |
Depends on:
No
|
| Enter 10 digit number with no spaces. Include area code for a landline | Text |
Depends on:
No
|
| Mother | Checkbox |
Check this box if your other parent is your mother. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Father | Checkbox |
Check this box if your other parent is your father. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Guardian | Checkbox |
Check this box if your other parent is your legal guardian. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Parent/Guardian Allowance to Return Home | ||
| No | Checkbox |
Check this box if your parent(s)/guardian(s) will not allow you to return home to live. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if your parent(s)/guardian(s) will allow you to return home to live. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Next Instruction for No | Text |
Please provide any specific instructions or a reference for the next step if your parent(s)/guardian(s) will not allow you to return home to live. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Parents' Living Arrangement | ||
| No | Checkbox |
Check this box if your parent(s) do not live together. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if your parent(s) live together. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| DummyCalcQ17 | Text | |
| Payment Details | ||
| 36.BankName | Text |
Depends on:
Yes
|
| 36.BSB | Text |
Depends on:
Yes
|
| 36.AccNo | Text |
Depends on:
Yes
|
| 36.AccountNames | Text |
Depends on:
Yes
|
| Permission to Contact Person from Question 15 | ||
| No | Checkbox |
Check this box if you do not give permission for us to talk to the person identified in question 15. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if you give permission for us to talk to the person identified in question 15. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Permission to Contact Person from Question 16 | ||
| Deny Contact for Person from Question 16 | Checkbox |
Check this box if you do not grant permission for the organization to contact the person identified in question 16. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Grant Contact for Person from Question 16 | Checkbox |
Check this box if you grant permission for the organization to contact the person identified in question 16. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
|
| Permission to Contact Person from Question 20 | ||
| No | Checkbox |
Check this box if you do not give permission for us to talk to the person identified in question 20. Fill only if 'Question 20' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you give permission for us to talk to the person identified in question 20. Fill only if 'Question 20' is 'Yes'.
Depends on:
Yes
|
| Permission to Contact Person from Question 22 | ||
| No | Checkbox |
Check this box if you do not give permission for us to contact the person identified in question 22. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Yes | Checkbox |
Check this box if you give permission for us to contact the person identified in question 22. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Postal Address | ||
| Postal Address Line 1 | Text |
Please enter the first line of your postal address.
|
| Postal Address Line 2 | Text |
Please enter the second line of your postal address.
|
| Postal Address Line 3 | Text |
Please enter the third line of your postal address.
|
| Postal Postcode | Text |
Please enter the postcode for your postal address.
|
| Previously Left Parents Home Status | ||
| No | Checkbox |
Check this box if you have not previously left your parent's home. Fill only if 'No, I do not live with my parents' is 'Yes'.
Depends on:
No, I do not live with my parents
|
| Yes | Checkbox |
Check this box if you have previously left your parent's home. Fill only if 'No, I do not live with my parents' is 'Yes'.
Depends on:
No, I do not live with my parents
|
| Number of Previous Departures | Number |
Provide the number of times you have previously left your parent(s)' home. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Privacy Notice Confirmation | ||
| Q37 | Text | |
| Reason for Leaving Home | ||
| Q24 | Text | |
| Reason for Not Trying to Sort Out Differences | ||
| Reason for Not Sorting Differences | Text |
Provide a detailed explanation of why you and/or your parent(s)/guardian(s) have not attempted to sort out your differences. Fill only if 'No (Question 26)' is 'No'.
Depends on:
No (Question 26)
|
| Reason for Parent/Guardian Not Allowing Return | ||
| Reasons for Not Allowing Return Home | Text |
Please provide a detailed explanation for why your parent(s) or guardian(s) will not allow you to return home to live. Fill only if 'No' is 'Yes'.
Depends on:
No
|
| Second Occasion Leaving and Returning Home | ||
| Second Occasion Left Home Day | Date |
Enter the day you left home for the second occasion. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Second Occasion Left Home Month | Date |
Enter the month you left home for the second occasion. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
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| Second Occasion Left Home Year | Date |
Enter the year you left home for the second occasion. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
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| Second Occasion Returned Home Day | Date |
Enter the day you returned home to live for the second occasion. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
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| Second Occasion Returned Home Month | Date |
Enter the month you returned home to live for the second occasion. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
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| Second Occasion Returned Home Year | Date |
Enter the year you returned home to live for the second occasion. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
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| Second Person/Organisation Contacted for Help | ||
| Second Contact Name | Text |
Please provide the full name of the second person or organisation that was contacted for help to sort out differences. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
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| No | Checkbox |
Check this box if going to the second person or organisation did not help improve your relationship. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
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| Yes | Checkbox |
Check this box if going to the second person or organisation helped improve your relationship. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
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| Support from Parent/Guardian | ||
| No | Checkbox |
Check this box if you are not receiving support from your parent(s)/guardian(s) or any other person. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
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| Yes | Checkbox |
Check this box if you are receiving support from your parent(s)/guardian(s) or any other person. Fill only if 'Do you live with your parent(s)?' is 'No'.
Depends on:
No, I do not live with my parents
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| Support Details Prompt | Text |
Indicate if you are receiving support from a parent, guardian, or other person by providing a brief confirmation or a keyword related to the support. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
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| Support Details Description | Text |
Provide a detailed explanation of the support you are receiving from your parent(s), guardian(s), or any other person, including examples such as food, help paying bills, rent, school fees, or regular money. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
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