Page 1 - Variety Tasmania Individual Grant Application 2023-2024

BEFORE YOU START... (Not Applicable)

Please read Variety's Grants Guideline s for eligibility criteria and other helpful information.

This form must be completed by the child's parent or guardian.

Is your child a permanent resident of Tasmania? *

Response required.Response required.

Yes

If your child resides in a State or Territory outside Tasmania, please visit www.variety.org.au to be redirected to your relevant State or Territory.

Have you read Variety's Grant's Guidelines? *

Response required.Response required.

Yes

Clear

CHILD'S DETAILS (Not Applicable)

Child's Name *

First name	Last name

Child's Age *

Child's Date of Birth *

Child's Gender *

Response required.Response required.

Female

Male

Prefer not to say

Clear

Description of child's sickness, disability or disadvantage *

Is this child of Aboriginal or Torres Strait Islander origin?

Yes

No

Other:

Clear

PARENT OR GUARDIAN 1 (Not Applicable)

Are you a single parent household?

Yes

No

Clear

Parent or Guardian 1 *

Title	First name	Last name

Relationship to Child *

Phone Number/s *

Email *

Address *

Address line 1

Address line 2

Suburb	State	Postcode

PARENT/GUARDIAN 2 (Not Applicable)

Parent or Guardian 2

Title	First name	Last name

Relationship to Parent or Guardian 1

Husband

Wife

Partner / Defacto

Other:

Clear

DEPENDENTS (Not Applicable)

Number of Dependents (under 18 years) *

Ages of Dependents *

ATTACH PROOF OF RESIDENCE (Not Applicable)

Please provide one copy of a recent notice or document that includes your name and address. For example, you may provide a copy of one of the following documents:

Copy of drivers licence
Vehicle registration
Electricity bill
Phone bill
Rates notice
Bank or credit card statement

ATTACH PROOF OF RESIDENCE

Attach a file:

ATTACHMENT METHOD *

Response required.Response required.

I have attached electronic copies (above); OR

I have posted paper copies to the Variety TAS office and written my grant application number on the top right of each page

Clear

Variety Tasmania Individual Grant Application 2023-2024

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APPLICANT DETAILS

BEFORE YOU START... (Not Applicable)

CHILD'S DETAILS (Not Applicable)

PARENT OR GUARDIAN 1 (Not Applicable)

PARENT/GUARDIAN 2 (Not Applicable)

DEPENDENTS (Not Applicable)

ATTACH PROOF OF RESIDENCE (Not Applicable)