Expression of Interest

EXPRESSIONS OF INTEREST

Thank you for your interest in the Making A Difference Community Support Program.

This form allows us to learn a little more about your child and your family's circumstances so we can carefully consider your Expression of Interest.

As the Community Support Program is fully funded by Making A Difference Occupational Therapy, the number of places available each year is limited. While we would love to support every family, submitting this form does not guarantee acceptance into the program.

All information provided will be treated confidentially and reviewed with care, compassion and respect.

We appreciate you taking the time to share your story with us.

Parent/Caregiver Full Name

Child's Full Name

Contact Email

Phone Number

Child's Date of Birth

Day

Month

Year

Address

Please provide us with the suburb of your current residence.

Tell Us About Your Child

Please tell us a little about your child and the challenges they are currently experiencing.

Why Are You Seeking Support?

What has led you to submit an Expression of Interest for the Community Support Program?

Situation

Are there any circumstances that are currently preventing your family from accessing Occupational Therapy?

Is there anything else you'd like us to know?

Is there anything else you would like us to consider when reviewing your Expression of Interest?

Please note: We may contact you if we require additional information to assist with the review of your Expression of Interest.

By submitting this form, you understand that submitting an Expression of Interest does not guarantee acceptance into the Community Support Program.