COVID-19 Emergency Hardship Fund Application

COVID - 19 Emergency Hardship Fund Application fund
Information provided in this application will be treated with complete confidentiality. It is only for disclosure to the APSA Inc. COVID-19 sub-committee and to only be used for conisderation of approval of funding requests.

Assistance up to the amount of $1000 will be available to successful applicants.

The sub-committee will consider each application on it's individual merits. The amount granted will be determined by the sub-committee taking into consideration the household circumstances and the APSA Inc. COVID-19 fund policy and procedures.

Categories:

Category 1: - coaches who applied for jobseeker / jobkeeper and been unsuccessful in their application,

- in households with NO other source of income, income includes youth allowance, carers pension, income from rental properties, investment funds etc.

Category 2: - households with only 1 source of income with priority to families with dependant children under 17 years of age.

Category 3: - coaches who do not meet the above criteria but can prove they are experiencing severe financial hardship.

Category 4: - coaches who find themselves in need of assistance due to domestiv abuse / violence (this assistance may be to help them relocate. have access to support services or any other means the sub-committee consider in the best interest of the applicant).

Category 5: - coaches who have tested positive to Coronavirus.

1. Basic information

Please fill out the below information.
Legal Name:*

First NameLast Name
Coaching name if different from above.

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Phone Number

Area CodePhone Number
Cell Number

Area CodePhone Number
Which State PSA are you a current member of:*

NSWPSAQPSASAPSAVPSAWAPSA
Are you an Australian Citizen?*

YesNo

2. Questionare

Complete the information pertaining to the category under which you are applying.
ALL CATEGORIES: *
Describe the reason(s) for needing financial assistance.
CATEGORY 1,2,3: Is any member of your household currently employed and earning an income from their employer:

YesNo
CATEGORY 1,2,3,4:
How many dependant children under the age of 17 yrs do you have?
CATEGORY 1,2,3
What was your coaching position as of Feb 2020?
CATEGORY 1,2,3 Is coaching your primary form of income?

YesNo
If not, provide further details:
e.g part time coach but no longer working in any other job etc
Category 1,2,3

Browse Files
Please provide proof of application or registration of jobseeker and / or job keeper and current status of your request e.g being assessed, approved, declined (this information can be obtained from your myGov account) OR provide proof that you are not eligible to apply for job keeper and / or jobseeker benefits. Cancelof
CATEGORY 1,2,3: Are you or a member of your household receiving any other financial payments at this time e.g youth allowance, carers pension, income from rental property etc

YesNo
If yes please provide further details.
CATEGORY 4:
Please advise of how we can be of the most assistance during this time and the safest way for us to contact you.
CATEGORY 5:

Browse Files
Please attach supporting documents that you have been tested positive for Coronavirus. Cancelof

Submitting!

I understand the fund has been set up for those enduring financial hardship and each application will be considered on an individual basis. The information I have provided, is to the best of my knowledge accurate at the time of my submission. If my application is approved and the information I have provided is found to be false or misleading I will be required to reimburse the fund and may have disciplinary action taken against me. My information will be treated with the upmost confidentiality. I agree to this application and any further information submitted by me, whether written or oral, to be distributed amongst the APSA Inc. COVID-19 sub-committee for the sole purpose of consideration of my application. I understand submission of my application does not guarantee approval of assistance.
Signature

Clear
Thank you for your submission. Your application will be assessed and you will be advised of the outcome in accordance with the APSA COVID-19 Emergency Hardship Fund Procedures.

Policies and Procedures can be found on the APSA Inc. website: www.apsa.net.au

If you're sure everything is filled out correctly, Click Submit!
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