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Stage one intake form

This form is to initiate your application process to the ASC Restorative Program. You are not required to provide all the details of your experience in this form.

Once this form has been submitted, you will be contacted by a Case Coordinator within 5 business days.

Your dedicated Case Coordinator will talk through your circumstances and the outcomes available to eligible applicants. You will be provided with information on available support options and you will be advised what further information we will need from you.

We are experiencing technical difficulties with the intake form – please send an email to or call 1300 345 616 and we can help you with your application.

Complete the Stage one intake form

Contact us

Our support team is available to answer any questions you may have:

Additional information

Help is available

If you would like help understanding the information or questions in this form, or assistance in completing it, please contact our Program representative via 1300 345 616 or and they can help you.

If you are unsure about your eligibility, we encourage you to contact us for a confidential discussion about the application process.


All information you provide and discuss will be treated as confidential and only shared for the purposes of applying to the Program and accessing Program outcomes.

For further information on how we will collect, hold, use and share your information, please see the ASC Restorative Program Privacy Collection Notice.

What happens next?

Once we receive your information, one of our Case Coordinators will contact you, usually within 5 business days. They will talk to you about eligibility for the Program, the outcomes available and your circumstances. This will help you to determine whether to submit a formal application to the Program.

We understand that accessing the Program may bring up difficult memories and emotions and that recalling what happened can be challenging. Support is available to you.

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