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S.H.E.W. Program Application Form

Sport Health Exercise & Wellbeing


Section A – Applicant Details

Title:MrMrsMsMiss


Child's Full Name: Birth Date: Age: Gender:
MF
MF
MF
MF
Please provide details of the activity and/or club your child will be participating in:
Club Name: Club / Organisation Address: Activity e.g. footy, gymnastics:
Child 1.
Child 2.
Child 3.
Child 4.
Child 5.


YesNo
YesNo

Your Connection to Community Housing.

Please provide the details of the person who is the main tenant in your household.

Title:MrMrsMsMiss

If you are unsure of these details, please contact the office on 4324 7617 or 1300 654 973 toll free for further advice.


Section B – Additional Information

Note: this information will help us better understand your reasons for applying for the SHEW Program

Are you a person:

  • of Aboriginal or Torres Strait Islander origin?
  • NoYes, AboriginalYes, Torres Strait Islander
  • from a language background other than English?
  • NoYes
  • with a disability?
  • NoYes
  • with special conditions at home? (e.g. Caring for children or living away from home)
  • NoYes

    How did you find out about the SHEW Program?
    InternetPLH Tenant NewsletterOther

    Section C – Applicants Statement


    Section D – Applicant Declaration

    Note: this section must be completed by the applicant or a parent or guardian if applicant is under 16 years.

    Provision of Personal Information

    YesNo

    YesNo

    YesNo

    YesNo


    Applicants who are 16 years of age or older at the time of this application, may sign this declaration. Where an applicant is under 16 years of age, this form must be signed by the applicant’s parent or guardian.

    Sign Here >

    Use your computer mouse to sign in the signature box. If you are on a mobile device you can use your finger.


    GUIDELINES TO COMPLETING THE APPLICATION FOR


    Section A - Applicant details (compulsory information)

    In this section, fill in the full details of the applicant applying for the SHEW Funds. Full details are required as
    incomplete forms may not be considered any further.

    Date of birth – Fill in your date of birth. If you are aged under 16 years, please include the name and contact details of your parent/guardian.

    Australian citizen/permanent resident – You must be an Australian citizen or permanent resident to be eligible for the Pacific Link Housing SHEW Program.


    Section B - Additional Applicant Information (optional information)

    Please indicate if you:

    • are Aboriginal and/or Torres Strait Islander
    • are from a language background other than English
    • have a disability

    You may like to tell us about any previous awards you have received. This will provide us with further background
    information.


    Section C – Applicant’s Statement (compulsory information)

    Completing the statement – You, the applicant, must complete the questions describing how you would benefit from
    receiving the SHEW.

    Space is provided on the application form to write your statement. Provide enough information in this section to fully answer each question. This is the information we will use to assess your application.


    Section D – Applicant’s Declaration (compulsory information)

    Provision of personal information – It is compulsory for you, the applicant, to certify that the personal information
    provided in the application form is correct. If this is not acknowledged, the application may not be considered any further.

    Provision of personal information to administer and disburse funds – It is compulsory for you, the applicant, to acknowledge that information from the application form (including personal details) will be collected, used and disclosed by Pacific Link Housing only for the purpose of assessing the application and administering funds for successful applicants. If this is not acknowledged, the application may not be considered any further.

    Release of details for publicity – There may be personal situations where an applicant’s details cannot be released to the public. Consent to publicity and/or public release of personal details in the media is optional and will not affect the assessment of the application.

    Signature – If you are 16 years old or over (at the time of the application), you must sign the declaration. If you are under 16 years (at the time of the application), your parent/guardian must sign the form.