Registration Do you consent for our team to contact you if we need more information to determine if this service is suitable for you:(Required) Yes No Do you consent for minimal information to be collected and stored by ICLA so we can determine if this service is suitable for you:(Required) Yes No Unfortunately, we will not be able to progress with your application without you consenting to being contacted. We encourage you to consider re-applying if you are able to provide this consent in future.APPLICANT DETAILSName(Required) Your first name Your last name Your contact number(Required)Your email address(Required) What is your preferred method of contact?(Required) Phone call SMS Email Other If other, please specify State(Required)WAQLDNSWVICSATASNTACTPost code(Required) Your Date of Birth(Required) MM slash DD slash YYYY Do you identify as indigenous?(Required) Aboriginal Torres Strait Islander Both Aboriginal and Torres Strait Islander Indigenous Identity not listed Neither Prefer not to say Do you identify as culturally and/or linguistically diverse? i.e. do you speak a language other than English at home, or were you born in a country other than Australia?(Required) Yes No Prefer not to say If yes, please provide details if you would like to:What gender, if any, do they identify with?(Required) Female Male Gender Diverse Agender Gender not listed Prefer not to say Do you identify as part of the LGBTQI+ community?(Required) Yes No Prefer not to say Do you identify with any mental health diagnoses?(Required) Yes No If yes, please provide details if you would like to:Do you consider yourself to have a disability?(Required) Yes No Prefer not to say If yes, please provide details if you would like to:I understand that eFriend is a service and offers virtual peer support sessions to connect with people feeling down, stressed, lonely, isolated or worried. I understand that eFriend is NOT a crisis, counselling or mental health treatment service.(Required) Yes No Are you currently living in Australia?(Required) Yes No Are you 18 years old or over?(Required) Yes No Unfortunately, we will not be able to proceed as eFriend is only available to Australian's who are 18 years or over. Please feel free to reach out to us at efriend@icla.org.au for more information.