Request for Support

Whitehorse City Council acknowledges the Wurundjeri Woi Wurrung people of the Kulin Nation as the Traditional Custodians of the lands and waters in and around Whitehorse. We pay our respects to Elders past and present, and recognise their continuing connection to land, waters, and community.

Whitehorse Youth Connexions values and celebrates the diverse cultures, identities, and experiences of all young people. We are committed to providing safe, inclusive, and accessible spaces where everyone feels welcome.

All Whitehorse Youth Connexions programs are staffed by qualified youth workers to ensure high-quality service delivery and the safety and wellbeing of young people.

If you have any specific needs or would like to discuss how we can best support your participation, please contact us on 03 8873 9140  before attending.

To learn more about our programs and services, please visit Young People

Privacy Statement

Whitehorse City Council (Youth Connexions) collects the personal information requested on this form for the purpose of registering participants in Youth Connexions programs and managing their participation.

The personal and health information collected will not be used or disclosed for any other purpose without your consent, except where required or authorised by law.

You may request access to, and/or correction of, your personal information held by Council by contacting the Council’s Privacy Officer on [insert phone number/email].

Your Privacy

We only ask for information so we can register you for our programs and make sure we can support you properly.

  • Your details are kept private and safe.
  • We won’t share your information with anyone else unless you say it’s okay, or if the law says we have to (for example, if someone’s safety is at risk).
  • You can ask to see or change the information we have about you at any time.

If you have questions about your privacy, just ask one of our team — we’re here to help.

Youth Connexions – Request for Support

Thanks for reaching out!

This form helps us understand how we can best support you.

  • You are welcome here — whoever you are, whatever you’re going through.
  • You only need to answer what you feel comfortable sharing.
  • Your information is private and confidential unless there are safety concerns.
  • Your request will be sent to our Youth Worker team, and you’ll hear back from us within 3 business days.

All fields are optional to provide information. 

About you

This section can be completed by a young person or someone supporting them such as a parent, carer, teacher, or youth worker.

Your role
Contact details
Best way to contact you
As specified above

If you or someone you know is in crisis, please contact:

  • Emergency (Police, Fire Ambulance): 000
  • Lifeline: 13 11 14
  • Kids Helpline: 1800 55 1800
  • SuicideLine Victoria: 1300 651 251
Your situation

This section can be completed by a young person or someone supporting them.

What kind of support are you looking for?

Please tick all that apply and add details if you want

Please describe your relationship to the young person and any key information you’d like us to know:

  • Is there something you’d like to change or improve in your life?
  • What would make things feel easier or better for you at the moment?
  • What are some things you enjoy doing or feel good at?
  • Who supports you in your life (friends, family, community)?
     
Safety and wellbeing
Do you feel safe at home, school, or in your community?
Next steps
How would you like us to follow up with you?
Select the checkbox to confirm this is a valid submission.