Media Inquiry Form

Date of Inquiry (required)

Contact Details

First Name: (required)

Last Name: (required)

Phone/ Mobile: (required)

Email: (required)

Role (required)

Media Outlet Name: (required)

Media Outlet Website:

Type of Media Outlet

Description of Request/ Story

Please include details regarding the story you’re working on and specific information or questions you’d like answered / covered in our response to you.

Description of Request: (required)

Services to be consulted/ represented in story

Sutherland Shire Family ServicesEngadine District Youth ServicesSouthern Sydney Women’s Domestic Violence Court Advocacy ServiceToolbox Talks Domestic Violence TrainingSutherland Shire Domestic Violence CommitteeSutherland Shire Child Protection Committee

Requirements of Engagement

On Camera InterviewAssigned Quotes from Subject Matter ExpertsSupporting Statistics

Deadline Date and Time: (required)

Date Story runs or airs:

Are you able to supply a draft for fact checking before publishing?

Send