Scouts for Refugees Grant Application

APPLICANT'S PERSONAL DETAILS
SURNAME	DATE OF BIRTH	SEX: M F
FULL GIVEN NAMES
PREFERRED FIRST NAME	YOUTH CONTACT NUMBER
ARE THEY CURRENTLY OR HAVE THEY EVER BEEN A MEMBER OF SCOUTS NSW? (Y/N)	MEMBER NUMBER (If Known)
HOME ADDRESS
TOWN/SUBURB	STATE	POSTCODE
YOUTH EMAIL
POSTAL ADDRESS (if not as above)
TOWN/SUBURB	STATE	POSTCODE
COURT ORDER: Is the Applicant the subject of any custody or access orders or arrangements?	YES NO

PRIMARY CARER DETAILS	(THIS PERSON IS THE PRIMARY CONTACT FOR THIS YOUTH MEMBER)
TITLE (e.g. Mr/Mrs)	GIVEN NAME	SURNAME
RELATIONSHIP TO APPLICANT	DATE OF BIRTH	SEX: M F
PREFERRED CONTACT NUMBER	HAVE YOU EVER BEEN A MEMBER OF SCOUTS NSW? (Y/N)	MEMBER NUMBER (If Known)
HOME ADDRESS (if different to Applicant)
TOWN/SUBURB	STATE	POSTCODE
EMAIL ADDRESS
WILL YOU BE REGISTERING YOUR ACTIVE KIDS REBATE WITH SCOUTS NSW?	Yes No
PLEASE INDICATE YOUR PREFERRED MEANS OF COMMUNICATION:	Email Post

SCOUT GROUP DETAILS	Joey Scout	Cub Scout	Scout	Venturer Scout	Youth Helper	Other
Membership Type:
with	Scout Group

ADDITIONAL INFORMATION AND COMMENTS	(Please continue any responses over the page if required)
(a) Why is Scouting important to you and your family?
(b) Please provide relevant information about family finances and circumstances. (Please indicate total income from all sources, expenses and total dependants covered)
(c) As Carer/Guardian, what assistance are you able to provide to the Scout Group?
(d) Is there any other information you would like to provide in support of your application?

The Scout Group is a community organisation. It exists because people like you want to make the individual training and development that Scouting is famous for, available for your children. Every family that joins the Group is encouraged to contribute in some way. Some families assist by serving on the management or fundraising committee, others prefer to assist in practical ways such as maintaining or fixing facilities or equipment, while others assist with the running of a Section as an Adult Leader or Parent Helper.

CHILD SAFETY IS OUR PRIORITY
All Adult Leaders undergo Police Checks, complete Child Safe Training and hold a valid and verified NSW Working With Children Check (WWCC). To find out more, please visit: www.nsw.scouts.com.au/about/child-safety.

Privacy Agreement:

I have received a copy of, or am aware of, the Scouts NSW Privacy Policy, and I consent to the information collected on this form to be used in accordance with the rights and obligations set out in that policy. Also, I acknowledge that any third party, about whom information on this form has been provided by me, has been informed of the Association’s collection of their information and that they are aware of the Scouts NSW Privacy Policy.

I accept that Scouts NSW may use electronic signatures as part of their processes.

Compliance with the Code of Conduct is expected of all Adults, Members and Associates, uniformed and non-uniformed, who work within the Movement, recognising that at all times they should act responsibly and exercise a Duty of Care.

I agree to accept the Scout Promise and Law and be guided by the Policies and Rules of the Association and Scouts Australia NSW.

All current policies are available from the Scouts NSW website www.nsw.scouts.com.au .

Information collected on this Grant Application will be treated with strict confidentiality and will only be viewed by The Group Leader and the Scouts for Refugees Management Committee.

Agreement and Undertaking:

I understand that if successful in obtaining a Grant, that the recipient is required to provide feedback on how Scouts for Refugees has a made a positive impact on their lives. This feedback may be in the form of a simple 100 word report/email every 6 months which is provided to the Scouts for Refugees Management Committee. The reports may be shared within the Scouting Community (with the identity of all recipients kept confidential).

Recipients (and Carers/Family) are expected to participate in Group based fundraising activities, and to make a small contribution towards annual costs. If the recipient fails to attend weekly meetings for four consecutive weeks, without valid reason, the Grant will cease. Grants are in place for a period of 12 months. Recipients can reapply for a grant at the conclusion of the 12 month period.

SIGNED:	(PRIMARY CARER)	DATE

For further information about Scouts for Refugees

please contact:

Scouts for Refugees: S4R@nsw.scouts.com.au
or
Contact Scouts Australia NSW: 02 9735 9000

When complete, please email form to: S4R@nsw.scouts.com.au

or Post To:	Scouts for Refugees

Scouts Australia NSW

Reply Paid 125

LIDCOMBE NSW 1825

ADDITIONAL INFORMATION AND COMMENTS	(Continued from Page 1)

OFFICE USE ONLY

APPLICATION RECEIVED BY	DATE	APPLICANT MEMBERSHIP NO.