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Application for Assistance
2023-08-14T10:51:56+08:00
Application For Assistance Form
Instructions
1. Please fill in the information below.
2. An item marked with
*
is needed.
3. Please draw your signature at the bottom of the screen.
4. Click on "Send Application" once you are ready.
5. You will be redirected to a confirmation page once the application has been sent to us.
SECTION A: Type of Assistance
Please select one of the following:
*
The form will change according to the options selected.
Hardship
Old People's Fund
Sports
Education
Carer
Medical
Funeral Travel
SECTION B: Personal Details
First Name:
*
Last Name:
*
Date of birth:
*
Day
Month
Year
Email:
Phone:
*
Address:
*
Please fill in all parts of the address below.
Street Address
*
Suburb
*
State
*
Postcode
*
SECTION C: Application for a child
Is this application for a child?
*
Please fill in a separate form for another child.
Yes
No
Child's Full Name
*
Date of birth
*
Day
Month
Year
Which school year is your child currently in?
*
For example, if your child is studying in Year 7, type in "Year 7".
SECTION D: Medical Assistance
Please provide the following information & documents for assistance relating to Medical:
A letter from the medical professional or social support worker
Letter from the medical professional or social support worker
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
You would also be able to take a photo of the document using your phone's camera.
Date of the appointment:
Day
Month
Year
SECTION E: Carer's Assistance
Please provide the following document:
A letter from the medical professional / social support worker
Letter from the medical professional / social support worker
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Tip: Push 'Select Files' and you can take a photo of the document using your phone!
Appointment Date
Day
Month
Year
Name of the Patient
What is your relationship to the patient?
SECTION F: Sports Assistance
Please provide one of the following documents:
Completed registration of the sports event, lessons or course
A support letter from the sports institution
Tax Invoice or Quote
Supporting Documents
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
You would also be able to take a photo of the document using your phone's camera.
SECTION G: Education Assistance
Please provide one of the following documents:
Completed registration of the event, lessons or course
An enrolment letter
Tax Invoice or Quote
Supporting Documents
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
You would also be able to take a photo of the document using your phone's camera.
SECTION H: Expenses Requested
Please provide details of the request:
*
Item
Store/Supplier Name
Amount requested?
Click on "+" to add more lines.
If you have requested for vouchers, please specify, e.g. Woolworths, Coles.
SECTION I: Why do you need help?
What has happened recently that has caused you to ask for help?
*
Please provide any other supporting documents that may be relevant.
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, doc, docx, jpeg, Max. file size: 8 MB.
You would also be able to take a photo of the document using your phone's camera.
If your application relates to attending a funeral, please provide a copy of the funeral notice.
SECTION J: Declaration
*
I declare that the above information is true.
*
Signature
*
TIP: You can draw your signature in the box below.
Click on the arrows to clear the drawing.
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