Request form special campaigns

Thanks for visiting Eureka Mums!

To access our services all caseworkers, social workers and maternal and child health nurses must be registered with Eureka Mums. If you are not yet registered, please register here prior to completing this form.

This form is to be used for special campaigns where you ask for certain items for multiple families, like "back to school", "one mother to another", etc.

For normal orders with one form for each family and the regular scope of items, please use this form.

For further assistance or for emergency requests, please contact the Social Services Coordinator via email

We look forward to receiving your request soon - thank you for your support of families in need.

Your Details

Your name*

Your organisation*

Your email*

Your mobile number*

example: 0400111333

Family Information

What Local Government Area does most of the families live in?*

Do most of the families identify as Aboriginal or Torres Strait Islander?*

Do most of the families have a health care card?*

What are the most common causes of disadvantage for these families? (You may select multiple items by holding down your Ctrl or command key.)*

Other disadvantages*

Is DHHS involved with most of these families/children?*

Have most of these families been affected adversely by COVID-19?*

Are these families connected with other support services? If so, who?

How many families are you requesting assistance for?*

How many children are in the families in total?*

How many are younger than 12 months (including if any one(s) due)?*

How many are we directly supporting with this request (including babies due to be born)?*

Items Required

Please enter the number of required items next to what you require. Please note we rely on donations, so we cannot guarantee supply but we'll do our best.

How many School Backpack Girl

How many School Backpack Boy

Please specify the stage for the backpacks: Kinder/Primary/Secondary

Please confirm that you agree with the terms of our Service Policy? *

Opening Times

Our opening hours for collections are: Tuesday and Thursdays 10am - 12pm. Mondays and Wednesdays 1:30pm - 2:30pm

Criteria for collection:

Pick up must be at least 5 business days from date of order. This is to give us enough time to prepare stock for you.

If this order meets this criteria please select your preferred collection date

Looking forward to receiving your request soon - thank you for your support of families in need.