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APPLICANT INFORMATION

Nameyour first name
Surnameyour last name
Date of birth (DD/MM/YYYY)
Phonea valid phone number
Residential Address
Addresscurrent address
City
Postcode
How long? (years / months)
Previous Address
Addressprevious address
City
Postcode
How long? (years / months)

APPLICANT EMPLOYMENT/PENSION INFORMATION

Employer Name
Addressemployer address
How long? (years / months)
Phonea valid phone number
Fax
City
Postcode
Position
Type
Annual income

SPOUSAL / PARENTAL / CARER INFORMATION

if applicable

Nameyour first name
Surnameyour last name
Date of birth (DD/MM/YYYY)
Phonea valid phone number
Addresscurrent address
City
Postcode
How long? (years / months)

SPOUSAL / PARENTAL / CARER EMPLOYMENT / PENSION INFORMATION

if applicable

Employer Name
Addressemployer address
How long? (years / months)
Phonea valid phone number
Fax
City
Postcode
Position
Type
Annual income

2ND PARENTAL / CARER INFORMATION

if applicable

Nameyour first name
Surnameyour last name
Date of birth (DD/MM/YYYY)
Phonea valid phone number
Addresscurrent address
City
Postcode
How long? (years / months)

2ND PARENTAL / CARER EMPLOYMENT / PENSION INFORMATION

if applicable

Employer Name
Addressemployer address
How long? (years / months)
Phonea valid phone number
Fax
City
Postcode
Position
Type
Annual income

ASSETS & LIABILITIES OF THE FAMILY

Home Value ($)
Home Liability ($)
Other Property Value ($)
Other Property Liability ($)
Personal Loan Value ($)
Personal Loan Liability ($)
Car Value ($)
Car Liability ($)
Credit Cards Value ($)
Credit Cards Liability ($)
Shares Value ($)
Shares Liability ($)
Other Assets Value ($)
Other Assets Liability ($)

TOTAL ASSETS ($)

[ FIELD130 + FIELD139 + FIELD138 + FIELD149 + FIELD148 + FIELD147 + FIELD150 ]

TOTAL LIABILITIES ($)

[ FIELD137 + FIELD141 + FIELD140 + FIELD146 + FIELD145 + FIELD144 + FIELD143 ]

MONTHLY EXPENSES FOR THE HOUSEHOLD ESTIMATE

amount per month or value

Rent/Mortgage Repayment ($)your full name
Rates/Water ($)your full name
Power ($)your full name
Telephone - Total of all phones ($)your full name
Petrol ($)your full name
Food ($)your full name
Education ($)your full name
Car Servicing & Insurance ($)your full name
Health Insurance ($)your full name
Medical Expenses ($)your full name
Other Expenses ($)your full name

TOTAL Expenses ($)

[ FIELD159 + FIELD162 + FIELD161 + FIELD160 + FIELD158 + FIELD156 + FIELD157 + FIELD155 + FIELD154 + FIELD163 + FIELD182 ]

YOUR REQUEST

Please provide background information to your request
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Please provide specific details of what you are requisition.
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Please attach copies of quotes or other supporting information
(Jpeg, png, or PDFs)
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PROVIDE SPECIFIC DETAILS OF ANY OTHER SUPPORT FROM GOVERNMENT OR OTHER ORGANISATIONS YOU HAVE APPLIED FOR TO SUPPORT YOUR REQUESTplease include if the application has been approved and if so for what value
OrganisationContact NameAmount ($)Decision (Approved/Declined)Reason (if declined)
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(2)
How did you hear about the Gold Coast Community Fund?
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If your application is approved, would you provide consent for the fund to share your story and images to assist with promoting the fund via publicity?We respect your privacy, your answer to this question will not affect the outcome of your application in any way.

LEGAL INFORMATION

What information do we collect?

The personal information collected and maintained by us generally includes your name, date of birth, gender, address, contact details. We also collect and maintain your sensitive information. This includes information about your health and financial situation.

How do we hold your personal information?

We may hold your personal information in a number of ways, including:

• in our computer systems or databases, which may involve storing data on storage or computer systems provided by third party suppliers; and/or

• in paper records;


How do we use your information?

We collect, use and exchange your information so that we can:

  • establish your identity and assess applications 
  • manage our relationship with you
  • manage our risks and help identify and investigate illegal activity, such as fraud
  • contact you,
  • conduct and improve our systems and improve the your experience
  • comply with our legal obligations and assist government and law enforcement agencies or regulators
We may combine personal information we receive about you with other information we hold about you. This includes information received from third parties and information collected.
When will we disclose information?
We may collect, use and disclose your information in ways where permitted by law. Although we will not collect, use or disclose sensitive information about you unless we need the information for one of our functions or activities and we have your consent (or we are legally required to do so).
Any assistance is at the absolute discretion at all times of the committee and its decision shall be final and without review. The committee will not be required to provide reasons for any decision to refuse any application.
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