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Application for Assistance
2021-07-13T08:47:03+00:00
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
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: 128 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: 128 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: 128 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: 128 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
Who is being paid?
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, Max. file size: 128 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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