FAHCSIA

APPLICATION FORM FOR FUNDING

FIND AND CONNECT SUPPORT SERVICES –

WESTERN AUSTRALIA

APPLICATION FORM FOR FUNDING UNDER THEFamily Support Program - Find and Connect

Information for applicants

Closing Date

Applications must be submitted by 2:00pm AEST
(12:00pm AWST), 3 August 2012.

How to lodge

Application Forms can be completed and submitted electronically via email at d must be lodged by the closing date.

Receipt of Application

Receipt of the Application Form will be acknowledged by email.

Questions and Answers

Should you have any questions about this ApplicationForm, please consult the Program Guidelines. If you cannot find the information you require please email .
Answers to any questions received by the Department will be posted on the Department’s website.
Questions will not be taken or responded to at any time during the review phase.

National Relay Service (NRS)

If you are deaf or have a hearing or speech impairment, you can use the NRS to contact any of the Department's listed phone numbers. To access a 1800 FaHCSIA number NRS users should phone
1800 555 677 or visit the NRS Website at

Program Guidelines

If you are completing this ApplicationForm you should only proceed if you have read the Program Guidelines. Review of applications will be based on the information provided in the Program Guidelines.

Information Use

Please note that FaHCSIA may use successful applicants’ information,
other than personal information, that has been provided in the applicants’ application, to assist FaHCSIA to:
(a)comply with the Australian Government requirement to publish the names of all funding recipients on the FaHCSIA website
(b)inform staff negotiating and establishing funding agreements of risks and issues which need to be addressed in the agreement for that program
(c)inform future assessments for applications in the same program, or
(d)inform assessments for applications for other programs.
Please indicate whether you agree to the department using the information (not personal information) you have provided in your application for the purposes listed at (a), (b), (c) and (d) above.
I agree
I do not agree

Part 1 Eligibility

1a Organisation type and financial status
Is your organisation or lead agency non-government?
Non-government
State/Territory, Local government
Is your organisation or lead agency not for profit?
Not for profit
For profit
1bOrganisation entity type
Please tick √ all applicable boxes.
Incorporated associationincorporated under Australian State/Territory legislation
Incorporated cooperativeincorporated under Australian State/Territory legislation
Aboriginal corporationincorporated under the Corporations (Aboriginal and Torres Strait Islander) Act 2006)
Organisation established under specific Commonwealth or State/Territory legislation
Company incorporated under Corporations Act 2001
Partnerships
Trustee on behalf of a trust
If you have not ticked any box from the list in 1b above, your organisation is not able to apply for funding. You should refer to the ProgramGuidelines.

Please note in particular that local governments and State or Territory governments are not eligible to apply.

Part 2Applicant details

2What is the legal name of your organisation?
This is the name that appears on all official documents and legal papers. It may be different to your trading name.
All further responses within this Application Form must relate to this entity.
This is the legal entity that FaHCSIA will enter into Funding Agreements with.
3What is the trading name of your organisation?
This is the name your organisation trades or provides services under.
4Does your organisation plan to sub-contract any or all of the service provision, if this application is successful?
Yes
No
If yes, successful applicants may be asked to provide details of those sub-contracting arrangements and the organisations involved.
5What is your organisation’s physical address?
Enter the contact person’s address if your organisation does not have its own registered address etc.
Physical address (not a PO box)
Building/floor
Street no. and name
Suburb/town
State / Postcode
6What is the postal address of your organisation?
Same as above
Postal Address
Building/floor
Street no. and name or PO box
Suburb/town
State / Postcode
7What is the outlet name, where the service will be delivered? (If different, to Q2 or Q3.)
8What is the outlet’s physical address?
Physical address (not a PO box)
Building/floor
Street no. and name
Suburb/town
State / Postcode
9If more than one outlet is going to be used to deliver the service please list
Enter the contact person’s address if your organisation does not have its own registered address, etc.
Physical address (not a PO box)
Building/floor
Street no. and name
Suburb/town
State / Postcode
Physical address (not a PO box)
Building/floor
Street no. and name
Suburb/town
State / Postcode
10Who are the authorised Contact Persons for this application?
Preferred contact / Alternative contact
Title
First name
Surname
Position in organisation
Telephone number
Mobile number
Fax number
Business email address

Part 3Financial details

FaHCSIA is unable to fund your organisationif you do not provide bank account details.

12Does your organisation have an Australian Business Number (ABN)?
Yes
No
If yes, what is the ABN of your organisation?
If your organisation has an ABN branch number, please provide it here.
13Is your organisation registered for GST?
(Questions on GST requirements should be addressed to the Australian Taxation Office.)
Yes
No
14If you would like recipient created tax invoices (RCTIs) to be sent to an alternativeemail address to that of the preferred contact listed in Q10, please provide the new email address here.
If this is left blank RCTI’s will be sent to the preferred contact email address at Q10.
15Please provide details of your organisation’s bank account for payment should your application be successful.
Record the account details of the organisation listed at Q3 only. FaHCSIA will not make cheque payments or payments to a third party.
BSB number
Account number
Account name

Part 4 Financial viabilityand governance

16Please attach the following information:
  • Your organisation’s most recent audited financial statements (with previous year for comparison)

Are these statements fully compliant with Australian accounting standards?
Yes
No
If no, what is your rationale for preparation of financial statements which are not fully compliant with Australian accounting standards.
  • a current financial statement (income and expenditure,balance sheet, and statement of equity - this statement does not need to be audited).

  • an income and expense budget, for the financial year for which funding is sought. (Excluding the funding being applied for in this application).

17Please indicate if your organisation has the following:
Please tick where applicable(√ )
an organisation chart
duty statements for all positions
financial policy and procedures (systems manual)
delegations, (authorised financial delegates or decision makers)
business plan
risk management plan
minutes of board meetings
As a part of our financial viability verification process you may be asked to provide copies of these documents.
Can you provide copies of these documents within 7 days of a request by us?
Yes
No
18Please tick (√) if any of the following apply to your organisation.
Any form of litigation or enquiry during the past three years, current or pending.
NOTE: If you have settled a claim on confidential terms, please indicate this in your response
Any significant financial matter which may impact on the organisation e.g. insolvency or voluntary administration
Future commitments or contingent liabilities that might materially affect the organisation
If you have ticked any of the above (Q18) please provide a short explanation here (further information may be requested).

Recent funding applications

19Has your organisation recently applied for any other FaHCSIA funding?
FaHCSIA program name / Amount of funding / Period of funding / Date of application
20Has your organisation applied for funding from any other source to deliver thesame services covered by this application?
Program or funding source name / Contact officer / Date of application

Part 5Selection Criteria

The objective of this selection process is to fund applications that best represent value for money in the context of the objectives and outcomes for Find and Connect support services.

In determining whether or not the application represents value for money, the Department will consider:

  • the extent to which the organisation's service delivery model will achieve positive outcomes for Forgotten Australians and/or Former Child Migrants;
  • the organisation’s experience and capacity to deliver the proposed service;
  • the expertise and qualifications of staff; and
  • whether the proposed service is achievable within the specified timeframes and budget.

The Find and Connect support services are:

  • a 1800 information, advice and referral service for Forgotten Australians and Former Child Migrants;
  • service providers will be required to take carriage of the 1800 number for calls originating in their state/territory.
  • the 1800 number is expected to be operational between 9am and 5pm (local time).
  • the Department will purchase the 1800 number and divert all calls originating from that state/territory to the service provider.
  • data/reporting and call handling procedures will be negotiated with successful applicants.
  • skilled staff to assist Forgotten Australians and Former Child Migrants locate their records and provide support throughout the records release process and their efforts to trace their families where possible:
  • This element has a particular emphasis on:
  • supported access and release of records;
  • establishing professional and enduring relationships to ensure continuity for the client when using Find and Connect support services; and
  • establishing outreach services to provide Find and Connect support services to Forgotten Australians and Former Child Migrants in rural, regional and remote areas.
  • specialist trauma-informed counselling for Forgotten Australians and Former Child Migrants to assist them recover from their experiences in care and the consequential impacts on their relationships and functioning.

Your response MUST address:

Criterion 1. Service Delivery Model
  • proposed service and how it will be made operational:
  • 1800 information, advice and referral
  • records searching
  • supported release of records
  • trauma-informed professional counselling
  • facilitating restoration of family relationships where desired
  • outreach to ensure coverage across entire jurisdiction
  • peer support and social support programs
  • how your service will operate:
  • independence from past providers of care1or how any relationships between the service provider and past providers of institutional care will ensure the independence of this service2
  • providing a welcoming, nurturing and comfortable environment from a location/venue/facility that is not associated with or mirrors the physical environments in which children were in care last century3
  • easily accessible via public transport
  • disability accessible
  • how your service will ensure collaboration and integration with mainstream services such as aged care, health, housing and dental services
  • timeframes and proposed budget to deliver services, including achieving service commencement in September 2012
  • how your service will engage Forgotten Australians and Former Child Migrants in governance arrangements4
Criterion 2. Organisational experience
  • demonstrated understanding of the experiences of Forgotten Australians and Former Child Migrants and capacity to effectively engage and deliver professional services to the client group
Criterion 3. Professional Approach
  • relevant qualifications and demonstrated expertise of staff and management to work with Forgotten Australians and Former Child Migrants

Explanatory Notes:
1Past providers of care to children means Children's Homes, orphanages and other forms of out-of-home ‘care’ until 1989.
2 Senate Inquiry reports and State governments’ inquiry reports detail the neglect, deprivation of health and education, exploitation, physical abuse and sexual abuse many children, known as Forgotten Australians and Former Child Migrants, suffered in out-of-home care last century. The Australian Government made a national apology to Forgotten Australians and Former Child Migrants in 2009 for the mistreatment and crimes perpetrated against them. The Australian Government’s new Find and Connect support service is being established to assist Forgotten Australians and Former Child Migrants recover from the experiences and losses of their childhoods and the enduring impacts on their wellbeing and relationships.
Where applicants have historical and/or current associations with past providers of institutional and other forms of out-of-home care last century, a detailed description is required to demonstrate how these associations will be transparently identified and managed to ensure Forgotten Australians and Former Child Migrants will both perceive and experience a service that is independent from the influence or control of organisations that were responsible for their ‘care’ as children and against whom they may have, be in the process of or wish to pursue in the future criminal charges or claims for compensation against those institutions/organisations and/or individuals operating within those institutions/organisations.
Evidence must be provided of deep understanding and respect for the real vulnerability of Forgotten Australians and Former Child Migrants who experienced neglect and abuse during their time in ‘care’ as children, and demonstrate how the applicant’s historical and/or current associations with past providers of care will be managed so as not to create a barrier to Forgotten Australians and Former Child Migrants accessing the Australian Government’s Find and Connect support service and/or create potential conflicts of interest regarding criminal or compensation action Forgotten Australians and Former Child Migrants may seek the support of Find and Connect support services to help them pursue.
3 The location/venue/facility must have no perceived or actual associations with past care environments. It must provide an environment where Forgotten Australians and Former Child Migrants do not experience an association with the environments or ‘carers’ of their childhoods.
4 Governance arrangements must reflect an appropriate balance of representation by Forgotten Australians and Former Child Migrants. Representation on governance bodies by members who have an actual or perceived association with past providers of care must be transparent and supported by detailed strategies to mitigate against any perception by Forgotten Australians and Former Child Migrants that the Find and Connect support service is governed or influenced by those associated with past providers of care.
Adjust area size to suit

Part 6Declaration

Please complete the declaration
NOTE:
Applications being submitted by post MUST be signed. / I declare that:
  • the information,including financial information, contained in this form is true and accurate,
  • I have read the programguidelines,
  • I have read, understood and accept the terms and conditions of funding and my organisation will be able to fully comply with those conditions.
  • I understand that incomplete applicationsmaynot be considered,
  • I agree to receiving recipient created tax invoices (RCTIs) for this funding should this application be successful,
  • if and where any personal details of a third party are included, the third party has been made aware of, and given their permission for,those details to appearin this application.
  • I am not aware of any perceived or actual conflict of interest that will arise by submitting this application. (For more information please see page 5 of the Part BProgramGuidelines. Describe below any conflicts of interest that have been identified).
Please describe any conflict of interest that may occur from submitting this application
If any financial information requested at Q16 has not been submitted please list any missing documents here.
Signature / Date
Name (please PRINT) / Position in organisation

Funding agreement

Successful applicants must agree to and sign a funding agreement with the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA).

The terms and conditions of the standard FaHCSIA Funding Agreement are contained in the application documentation sent to your organisation.

Part 7Applicationchecklist

To ensure that your application is complete, use the following checklist.

Part 1 / Eligibility: Have you responded to all relevant areas?
Part 2 / Organisationdetails:Completed
Part 3 / Financial Details: All questions completed?
Part 4 / Financial Viability:Have you provided the documents requested at Q16, and completed all questions?
  • Short explanation to question 18 has been attached if required

Part 5 / Response to selection criterion: Have you addressed the selection criterion, in this application, in line with theProgramGuidelines?
Part 6 / Declaration: Have you read and completed the declaration carefully?
Part 7 / Applicationchecklist (this part): Have you completed the application checklist?

Note:Applicationsthat are incomplete may not be considered.

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