Application Form – Organisations

Your Name:

Name of Organisation:

Street Address

Street Address 2

State
QLDNSWVICSANTTASWAACT
Post Code

Postal Address

Postal Address 2

State
QLDNSWVICSANTTASWAACT
Post Code

Phone 1

Phone 2

Fax

Email (required)

Please provide a brief summary of your organisation. Please include your purpose, activities, target population, and how you are funded.

Background: Does the community you serve identify with any of the following?

Other


Does your organisation currently run any similar programs (e.g. resilience or social skills programs)?
 Yes No

If Yes, which program(s)?


How do you intend to supply workbooks for the children involved (please request a price list for the discounted workbook prices)?
 Apply for grants/funding for this purpose Use existing funding Give families the option of purchasing
Other


Would you like to apply for:
 Option 1: Staff in-service Option 2: Staff to attend workshops

If you are applying for Option 1, please answer the following questions:

Which program(s) would you like your staff trained in?
 Fun Friends (4-7 years) FRIENDS for Life (Child: 7-12 years) FRIENDS for Life (Youth: 12 – 17 years)

Would you be willing to collaborate with surrounding schools / organisations to participate in the training workshop (please specify)?  Yes No

How many participants do you estimate would be in attendance at the workshop?

Are you able to provide:

1. Venue?  Yes No

2. Data projector?  Yes No

3. Laptop?  Yes No

What are your preferred dates for the in-service?

If you are applying for Option 2, please list the name(s), position(s) and preferred training dates of staff who wish to attend (see News and Events on our website).


Why do you think your community would benefit from these programs?


Questions/comments?


Form submitted by Of organisation
Date
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