Getting It Together Scheme

Getting It Together Scheme

EXAMPLE Brokerage Application

GITS is funded by FaCS Alcohol & Other Drugs Program. Funding is available for young people aged 12-16 years with current/recent alcohol and/or drug misuse problems who require assistance to address a range of issues. It is acknowledged that young adults aged 17-24 years may experience difficulties accessing such services; therefore some flexibility exists for providing services to these older clients.

Each brokerage application may be available for a maximum of $300.

Brokerage will not be considered unless all sections of the application are completed. Incomplete applications will be returned.

Application must be returned by email and typed.

Handwritten and faxed applications will not be accepted.

If you would like additional information or would like to discuss this application further, please contact Astrid Gearin on 4922 1508 or .

Date of Application / 20/01/2016
Client Name / KATE DOE
Age / DOB / Age = 16 D.O.B= 03/01/2000
Gender / Male Female Other………………..
Does YP have a Diagnosed Disability / Yes No
AFS and Depression
Aboriginal/
Torres Strait/ / Yes No
Yes No
Anglo/ other Ethnic Background / Provide Detail- Australian Aboriginal / Maori
eg Anglo, Maori, Iranian
Amount of Brokerage / $300
Purpose of Brokerage / □ Clothing
□ Education
□ Financial / Material Aid
□ Health / Medical Services
□ Meals
□ Rent in Advance
□ Rental Bond
□ Therapeutic Services
□ Transport

Worker Name & Contact Details / Mary Smith – 0400 00 00 00
Agency / YOUTH Co. Maitland

Outline purpose & details of brokerage application

* Must include issues of alcohol and/or drug misuse/ barriers

REQUEST:

Clothing & Membership KATE has a long history of Alcohol and marijuana use. Kate currently resides with here Aunty and 2 cousins in Government housing. She left home due to her parent’s alcohol abuse and DV and family violence.
KATE is not currently linked in with Centrelink and is experiencing financial hardship. KATE does not have any clothes that are suitable to commence employment seeking or sit for job seeking interviews or for her personally for fitness and social activities. Kate is a very active and driven young women who is very eager to quit for drug use and start fresh in her Aunty home, she hopes that being in an environment without D&A she will be able to ‘kick her bad habits’ and meet new friends and get healthy via Gym Memberships for Zumba groups and a fitness couch.
KATE currently is involved with YOUTHSPACE and is undergoing Alcohol and Other Drug counselling through there D&A Partnership Program. KATE states that she would like to obtain clean casual clothing so he can feel comfortable in the community and not feel judged
KATE also states she would like to be able to be dressed professionally and approach perspective employers with goal of obtaining some casual employment..
KATE’s states that since a very young age she has been partaking in alcohol & marijuana use due to exposure during her childhood in home and with her community and family friends and has AFS due to her mother’s drinking while she was in utero.
KATE has recently reduced her use of marijuana and has a good record in attending all YOUTHSPACE and Youth Co Maitland appointments.

1. Brief summary of Case Plan

*How does brokerage assist young person in their case plan?

KATE’s case plan goals are as follows;
Assist in developing a resume.
Assist in applying for jobs, interview skills, and job seeking skills.
Assist in gaining suitable identification.
Assist with process of Centrelink application –
Assist with funding for clothing/interview clothing.
Assist with obtaining Driver’s License.

Assist with promotion psycho social & health promotion activities.

1. Expected outcome/s of brokerage in relation to Case Plan

If KATE is granted brokerage for the above requested items the hope is that she will be able to feel more comfortable when in the community and more confident within herself, allowing her to reach her full potential and personal goals. The brokerage will assist KATE will be able to approach perspective employers in regards to job applications and attend psycho social & health promotion activities. The hope is this support will aid KATE to continues on a positive path away from Drug and Alcohol environments and dependency..

5. Payment details

a) Your Service will purchase goods and send invoice for reimbursement invoice made out to: Samaritans GITS Program GITS along with proof of payment

b) Your Service will send invoice directly from the supplier outlined in application- invoice made out to: Samaritans GITS Program

c) Can you please order vouchers for company mentioned in application ( Kmart, Woolworths, Big W, Coles/Myer)

Office Use Only

Brokerage No: ______

Date Received: ______

Date: ApprovedDate: Not approved

GITS Brokerage Application updated 20/01/16