Back to the Classroom Application Form (Adult with CF with dependent children)

BACK TO THE CLASSROOM APPLICATION FORM

Please use this form if you are an adult with CF on a low income who has dependent children attending school in 2025.
CFT understands that living with CF has significant financial implications. With the cost of living continuing to be high, we also know that children returning to school can be an additional expense that can strain household expenses.

This program has been made possible by a generous grant from the MyState Foundation that enables us to offer this program in 2025.

Who is eligible?
- CFT will provide $200 to each child with CF in kindergarten to grade 12 in 2025 to assist with back-to-school expenses.
- Adults with CF on low income who have school-aged children will be eligible for $100 for each child in kindergarten to grade 12 in 2025.
How do I make a claim?

1. Complete this online form if you are an adult with CF who has dependent children attending school in 2025 and you are on a low income.

2. If you are a parent/carer of a child/children living with CF in 2025, you will need to fill out a different form that can be found here

2. CFT will endeavour to process your application within 7-10 days (subject to staff availability).
Name of Adult with CF*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Post Code
Email*
example@example.com
Mobile Number*
Please enter your mobile number
DEPENDENT CHILDREN
How many dependent children do you have that will be attending school (Kinder to Year 12) in 2025.
Name of child*

First NameLast Name
Date of Birth*

MonthDayYear
Date
What school is your child attending in 2025?*
Name of School
What grade will your child be in this year?*
Name of additional child

First NameLast Name
Date of Birth

MonthDayYear
Date
What school is your child attending in 2025?
Name of School
What grade will your child be in this year?
Name of additional child

First NameLast Name
Date of Birth

MonthDayYear
Date
What school is your child attending in 2025?
Name of School
What grade will your child be in this year?
Do you currently have a Health Care Card?*

YesNo
Do you currently receive any Commonwealth Government subsidies, allowances or benefits (eg Pension, Rent Assistance etc)?*

YesNo
If you answered "yes" to the question above, what type of benefit do you currently receive?
Please tell us the name of the subsidy you receive.
BANK ACCOUNT DETAILS

Please provide the bank account details that you'd like us to pay the money into.
BSB*
Account Number*
Bank account holder*
Name
DECLARATION

I declare that all information I have provided to Cystic Fibrosis Tasmania is true and accurate. I understand if it is found that I have knowingly provided false or inaccurate information, I may no longer be eligible to be a member or receive any or all of the services and benefits provided by Cystic Fibrosis Tasmania.

I understand this subsidy has made available as a one-off payment in 2025 thanks to a grant from the MyState Foundation and that it is unlikely that the program will be offered beyond this year.
E-Signature Name*
Date*

DayMonthYear
Date
Should be Empty:

BACK TO THE CLASSROOM APPLICATION FORM

DEPENDENT CHILDREN

BANK ACCOUNT DETAILS