Individual Applications - Gold Coast Community Fund

Step 1 of 5

Applicant Contact Information

Please include details here of the individual that is requiring funding.

Applicant Name(Required)

First Last

Applicant Date of Birth(Required)

Applicant Contact Phone Number(Required)

Applicant Email Address(Required)

Email Address Confirm Email Address

Applicant Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code Country

Proof of Address(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB, Max. files: 5.

Drivers License, Utility Bill, Centrelink Document.

Living situation(Required)

Renting

Owner Occupier

Public/Social Housing

Temporary/Transitional Housing

Crisis/Emergency Accommodation

Staying with friends or family

Other

Details of the Request

Which of the following best describes the primary reason for applying for this grant?(Required)

Domestic or Family Violence

Homelessness or Risk of Homelessness

Disability

Mental Health Challenges

Loss of employment or reduced income

Caring responsibilities (eg unpaid carer for family member)

Serious illness or injury

Other

Please provide the Gold Coast Community Fund with as much information as possible in order to assess your application for assistance. Include any background information that will be helpful to tell your story, explain your current situation and why you require the assistance.(Required)

Please provide 100 words or more. We need good detail to properly assess.

Please provide specific details of what you are requesting support with. Include details, amounts and any due dates. If you are requesting items, bills, rent etc, please ensure you attached the documents in your application.(Required)

Please provide 100 words or more. We need good detail to properly assess.

Please upload any supporting documents (bills, expenses, medical, support letters, clinicians etc.)

Drop files here or

Accepted file types: jpeg, jpg, png, pdf, Max. file size: 256 MB.

(Jpeg, png, or PDFs)

To assist with processing your application, please upload any supporting documentation you have.

Please ensure the information shows income/quotes of the items you are requesting.

Recent Centrelink statement
Recent payslip
Quotation for item requested
Letter of support from medical professional

Has this applicant received previous support from Gold Coast Community Fund(Required)

Select an option from the dropdown.

Have you applied for help from the Government or other organisations for this situation?

Organisation

Contact Name

Amount ($)

Decision (Approved/Declined)

Reason (If Declined)

How did you hear about GCCF?(Required)

Legal Information

What information do we collect?

The personal information collected and maintained by us generally includes your name, date of birth, gender, address, and 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 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 permitted by law. We will not collect, use or disclose sensitive information about you unless it is required for one of our functions or activities and we have your consent (or we are legally required to do so).

Committee discretion

Any assistance is at the absolute discretion of the committee. Its decision shall be final and without review. The committee will not be required to provide reasons for any decision to refuse an application.

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?(Required)

Yes

We respect your privacy, your answer to this question will not affect the outcome of your application in anyway

Individual Application Form

Need Assistance? Use the form below and submit your application.

Applicant Contact Information

REFERRER/CARER INFORMATION

Income Details

Liabilities, Loans & Assets