Agency
PLACEMENT VACANCY FORM
Agency details
Agency name
Address
Contact name
Phone
Fax
Email
Service mix
Number of general foster care places
Number of intensive foster care places
Number of residential care places
Number of therapeutic care places
Number of family group home places
Number of supported independent living places
Number of emergency respite places
Placement vacancy details
Type of placement (tick one box only)
Emergency respite care

General foster care

Intensive foster care

Residential care

Therapeutic residential care

Family group home care

Supported independent living

Duration of placement (tick one box only)
Emergency

Temporary

Short-term
Long-term

How many children or young people are currently in this placement?
How many additional children or young people can the placement accommodate?
Is the placement available now?
Yes

No
If ‘no’, date placement will
become available

Placement location
Placement target group
What age range can this placement accommodate?
What level of need can this placement meet?
Low

Moderate

Is placement suitable for a sibling group?
Yes

No

Is placement suitable for Aboriginal or Torres Strait Islander
children or young people?
Yes

No

High


Is placement suitable for children or young people from
culturally and linguistically diverse (CALD) backgrounds?
Yes
Current mix of children in the placement or service
Outline any factors relating to the current mix of the
placement/service which need to be considered before a
referral is made.
Completed by
Signature
Date
 (provide details below)
No
