2020-21 Tenant Participation Grant (TPG) Application Form ... · the kind of support applicants may...

2020-21 Tenant Participation Grant (TPG) Application FormForm Preview

Overview

Before You StartPlease refer to the 2020-21 Tenant Participation Grant (TPG) Program Guidelines beforecompleting your application form.For a copy of the Guidelines and for updates and answers to questions please visit:http://www.communityservices.act.gov.au/home/grantsApplicants must be over the age of 18 to complete this form. If you are filling out this formon behalf of a minor (child under 18 years of age) please provide your details in the form.If you have any questions about the application process or require assistancein filling out the form please contact Service Funding Support Team by [email protected]

Section 1: Eligibility* indicates a required field

Note: Please refer to Section 6 of the Guidelines HERE. If you do not meet any of the beloweligibility criteria you should not proceed with this application.

1.1 Are you over the ageof 18? *

○ Yes○ No

1.2 Do you live in theACT? *

○ Yes○ No

1.3 Please uploadevidence of your ACTresidency. *

Attach a file:

Evidence of residency must state your current address, have adate of issue displayed and must not be older than 6 months.For example a copy of a recent rates notices, rent or utilitystatement, drivers’ licence (both sides) or a concession card ifthese have your current address on it. Evidence can be uploadedin the form of a scan, photo image, screenshot, or an onlinestatement/PDF. If you are having difficulties in uploading orscanning your evidence, you can contact the support officerlisted in the guidelines.

1.4 What is your tenancytype? *

○ ACT Public Housing (Housing ACT)○ ACT Community HousingTo be eligible for this Grant you must be an ACT social or publichousing tenant.

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1.4 a) Please enteryour Tenancy PaymentReference Number(TPRN). *

1.4 b) What date did youstart the tenancy? *

Must be a date.

1.4 a) Please select yourCommunity Housingprovider. *

Other:

1.4 b) What date did youstart the tenancy? *

Must be a date.

1.4 c) Do you pay up to25% of your income? *

○ Yes○ NoPlease note, if you are unsure about your subsidised rent, pleaseget in contact with your provider, as we will be confirming youreligibility with your provider.

1.5 Will the activitiesyou are applying foroccur in the ACT? *

○ Yes○ No

Please explain why your activities will not occur in the ACT? *

1.6 Have you receivedany grants from the ACTGovernment in the lasttwo (2) years? *

○ Yes○ No

If yes, please provide details: *

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1.7 Have you metacquittal conditions forprevious grants fundingreceived from the ACTGovernment? *

○ Yes○ NoI.e. have you provided evidence through receipts of how themoney was used?

Section 2: Personal Details for the Primary Household Requestingto Receive Funding* indicates a required field

Applicant * Title First Name Last Name

Household to ReceiveFunding Home Address *

Address Suburb State Postcode

Home Phone Number Example 02 62078830

Mobile Phone Number * Email * Postal Address (ifdifferent from above)

Address Suburb State Postcode

The following information is requested to enable the ACT Government to better identifythe kind of support applicants may find useful to complete their application, as well asto support the assessment panel to evaluate the needs of applicants and the potentialoutcomes of awarding each grant.

2.1 Which age group areyou in? *

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2.2 Do you or anymembers of yourhousehold identify asAboriginal or TorresStrait Islander? *

2.3 In which countrywere you born? *

○ Australia○ Other:

If you were not born in Australia, please write in the name ofyour country of birth at ‘Other’

2.4 Which language doyou mainly speak athome? *

☐ English☐ Other:

If it is not English, please write in the main language you speakat home at ‘Other’

2.5 Which of thefollowing best describesthe nature of yourhousehold? *

Other:

Carers, family or friends staying for an extended period orfrequent visits should not be considered while answering thisquestion.

Section 3 Applicants* indicates a required field

How many peopleare you applying forgrant funding in thishousehold? *

○ 1 ○ 2 ○ 3 ○ 4 ○ 5 ○ 6 ○ 7 ○ Other:

Activity details for your chosen funding category

NOTE: Eligible activities have been expanded for this year’s Program to include online basedactivity options that support participation under social distancing requirements due toCOVID-19. Please refer to Section 5 of the Guidelines for further information on eligibleactivities HERE.Your response to the questions in this section will support the assessment panel to evaluatethe benefits your chosen single activity will provide to the recipient or household, and howclosely this activity aligns to the chosen funding categories. Clearly outlining these factorswill provide greater support to your application and make it easier to assess.Note: If you access support services, they may be able to assist you with completing thissection.

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Applicant #1

*Title First Name Last Name Age *

Must be a number.

3.1 What funding category are you applying for? *☐ Life skills activities☐ Education and work activities☐ Social activitiesYou can select more than one category if your activity has crossover between the categories, as longas the activity meets one.

3.2 What type of activity are you choosing to participate in? *

for example Touch Football.

3.3 Please outline what your activity is and describe how participating in thisactivity will contribute to your physical, social and/or personal development. *

For example: What is the activity and how often does it happen? Does the activity involve otherpeople? What does the opportunity to participate in this activity provide to the recipient and themembers of their household/community? What would it mean to the recipient if they were funded toparticipate?

3.4 COVID-19 related question. We appreciate the COVID-19 Pandemic hassignificantly affected households in different ways, and this may change theway in which you would have originally applied for the TPG Program. If thisis the case for your household, could you please provide a short responsedetailing your current situation on how the pandemic has affected your abilityto participate in your chosen activity, and any information on how you canadapt your participation in your preferred activity to adhere to the currentsocial distancing and isolation restrictions. *If this does not apply to you, pleasedisregard.

Applicants must clearly outline how they will proceed with the activity in an adapted format, forexample registering for an online website to learn the guitar with a registered music teacher providingthe lessons.

3.5 When do you estimate the activity will commence, and how long will theactivity run?

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Please note if the activity occurs before the 3rd August 2020 the funding will not be eligible, asactivities cannot have occurred before the Program opened. Please also note that while you are able toapply for funding from this date, you may not receive notification about the success of your applicationfor a few months to allow for processing, and if your application is not successful you will need tocover the costs of your activity yourself.

3.6 Please provide evidence of the chosen activity you have described. This canbe in the form of an email outlining your request for availability, an online quoteof the estimated costs of the activity, and/or confirmation of registration etc. *

Evidence of registration must be provided, however if needed it can be submitted with your acquittalform if successful in receiving an offer. NOTE: If you are applying for support for childcare whenattending education or training activities, evidence is required for both the enrolment of childcare andthe chosen educational activity.

Attach a file:

Applicant #2

Name *Title First Name Last Name Age *

Must be a number.





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3.5 When do you estimate the activity will commence, and how long will theactivity run? *




Attach a file:

Applicant #3


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Must be a number.










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Attach a file:

Applicant #4


Must be a number.






3.4 COVID-19 related question. We appreciate the COVID-19 Pandemic hassignificantly affected households in different ways, and this may change theway in which you would have originally applied for the TPG Program. If thisis the case for your household, could you please provide a short responsedetailing your current situation on how the pandemic has affected your ability

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to participate in your chosen activity, and any information on how you canadapt your participation in your preferred activity to adhere to the currentsocial distancing and isolation restrictions. *If this does not apply to you, pleasedisregard.






Attach a file:

Applicant #5


Must be a number.

3.1 What funding category are you applying for? *☐ Life skills activities☐ Education and work activities☐ Social activities

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Attach a file:

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Applicant #6


Must be a number.








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Attach a file:

Applicant #7


Must be a number.





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Attach a file:

Applicant #8

Name *Title First Name Last Name

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Age *

Must be a number.









Please note if the activity occurs before the 3rd August 2020 the funding will not be eligible, asactivities cannot have occurred before the Program opened. Please also note that while you are able toapply for funding from this date, you may not receive notification about the success of your application

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for a few months to allow for processing, and if your application is not successful you will need tocover the costs of your activity yourself.



Attach a file:

This section asks about your household need for support/assistance.

3.7 Do you, or anymember of yourhousehold, havedifficulties with thefollowing activities dueto a physical, mentalor emotional healthcondition that is longterm (lasting six monthsor more)? *

○ Yes ○ NoIf yes, please answer the following questions relevant to eachapplicant:

Applicant #1 Applicant #2 Applicant #3 Applicant #4Difficulty seeing,even if wearingglasses.

Difficulty hearing,even if using ahearing aid.

Difficulty walking orclimbing stairs.

Difficultyremembering orconcentrating.

Difficulty withself-care such aswashing all over ordressing.

Difficultycommunicatingusing your usual(customary)language (e.g.

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understanding orbeing understoodby others)

Applicant #5 Applicant #6 Applicant #7 Applicant #8Difficulty seeing,even if wearingglasses.

Difficulty hearing,even if using ahearing aid

Difficulty walking orclimbing stairs

Difficultyremembering orconcentrating

Difficulty withself-care such aswashing all over ordressing

Difficultycommunicatingusing your usual(customary)language (e.g.understanding orbeing understoodby others)

Section 4: Budget Information* indicates a required field

4.1 Budget (GST Exclusive)

Please note the following items WILL NOT be funded as outlined in the Guidelines:1.Activities or items that do not achieve social, life or educational participation.2.IT equipment and IT hardware.3.Activities that do not occur in the Australian Capital Territory.4.Activities or items which have already taken place prior to the TPG program opening.5.Private or public events such as festivals, parties and celebrations.6.Travelling allowances, including overseas travel.7.Activities where other sources of funding are more appropriate.8.Activities which could be seen as inappropriate, poor value or offensive.

4.2 Expenditure description

Please provide a list of all items each individual applicant/s are seeking funding for toperform their chosen single activity.For example:

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Row 1 - Applicant 1; Applicant Name: Mark Smith; Activity and/or item: FootballRegistration; Total amount of TPG requested: $320; Overall cost per item: $350

(Click "Add More" button to insert new row)

Row 2 - Applicant 1; Applicant Name: Mark Smith; Activity and/or item: Football boots;Total amount of TPG requested: $80; Overall cost per item: $150

(Click "Add More" button to insert new row)

Row 3 - Applicant 2etc.

Applicationnumber:

ApplicationName:

Activity and/oritem

Total amountof TPG fundingrequested peritem

Overall cost peritem

Must be a dollaramount.Must be a dollaramount and nomore than 400.

This section is foryou to highlighthow much theactivity costsoverall, as weappreciate that$400 may not covereverything. Wecannot providemore than $400 perperson, howeverproviding thisfigure gives theassessment panel abetter picture of thecosts involved foryou to participate.Must be a dollaramount.

Applicant 1Applicant 2Applicant 3Applicant 4Applicant 5Applicant 6Applicant 7Applicant 8

4.3 Total amount of TPG funding requested for chosen activity per applicant.

Applicant #1 *$Must be a dollar amount and no more than 400.

Applicant #2 *

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$Must be a dollar amount and no more than 400.







4.4 Total amount ofTPG funding requestedfor the household (GSTExclusive) *

$This number/amount is calculated.Must be a dollar amount no greater than $400 per person (Total= $requested amount x number of people in the household)

4.5 Overall activity costfor the household (GSTExclusive) *

$This number/amount is calculated.This section is for you to highlight how much the activity costsoverall, as we appreciate that $400 may not cover everything.We cannot provide more than $400 per person, howeverproviding this figure gives the assessment panel a better pictureof the costs involved for you to participate.

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4.6 If you are offered agrant that is less thanthe amount needed,would you still be ableto proceed with thechosen activity? *

○ Yes○ No

Please provide a brief explanation for your answer. If you answered yes, pleaseexplain how your activity will still be possible. *

I.e. If you requested funding for football registration and football boots, can you still proceed withthe football activity if the football boots requested are not funded because (for example) the amountrequested for registration and boots exceeds the $400 limit per person?

Please provide a brief explanation for your answer. If you answered no, pleaseexplain why you cannot proceed. *

I.e. If you requested funding for football registration and football boots, can you still proceed withthe football activity if the football boots requested are not funded because (for example) the amountrequested for registrations and boots exceeds the $400 limit per person?

4.7 Have you applied forany other grants to fundthis activity? *

○ Yes○ No


4.8 Will you receive in-kind support for theactivity? *

○ Yes○ NoIn-kind support is a donation of goods or services, time orexpertise rather than cash or appreciated property which isconverted into a dollar value.


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Section 5: Feedback, Review and Submit* indicates a required field

5.1 Certification - Individuals

I certify that to the best of my knowledge the statements made within this application andthe information provided is true and correct. I understand that if the Community ServicesDirectorate approves the grant, I will be required to accept the terms and conditions of thegrant as outlined in the grant guidelines, application form and Deed of Grant.The Territory may wish to contact you to seek feedback on the application form.If you are successful, the Territory may contact you to seek permission to publishinformation about your application and how the grant benefited you.

I agree * ○ Yes○ No

Name * Title First Name Last Name

Date * Must be a date

Privacy Notice

In compliance with the Information Privacy Act 2014 (the Act) personal information onthis form may be stored in the Community Services Directorate records and may alsobe used for statistical research, information provision and evaluation of services. Yourpersonal information may be disclosed to other agencies and third parties for purposesrelated to this application and/or monitoring compliance with the Act. Except in thesecircumstances, personal information will only be disclosed to third parties with your consentunless otherwise required or authorised by law.

5.2 Additional Information

Is there any additional information or documentation you would like to include? (i.e. supportletter)

Additional InformationUpload

Attach a file:

5.3 Feedback

You are now coming to the end of your application process and before you REVIEW andclick the SUBMIT button, please take a few moments to provide some feedback. We valueany feedback you may have regarding the grant’s application process.

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Please indicate how you heard about the 2020-21 Tenant Participation Grant(TPG) Program (please select all that apply):☐ ACT Grants Portal (www.grants.act.gov.au)☐ Housing ACT☐ Child Youth Protection Services☐ SMS☐ Email☐ Mail☐ Flyer/Postcard in Gateway☐ Housing Manager☐ Word of mouth☐ Facebook☐ Community Services Directorate☐ Community Housing Provider☐ CIT / Tertiary Education☐ Library☐ School☐ Other:

Do you have any other suggestions as to how we can spread awareness of theseGrants?

Please indicate how you found the online application process:○ Very easy ○ Easy ○ Neither ○ Difficult ○ Very difficult

How many minutes did it take you to complete this application?

Please estimate in minutes e.g. 1 hour = 60 minutes. Must be a number only.

Please provide us with any improvements and/or additions to the applicationprocess / form that you think we need to consider:

If you are successful with receiving a TPG grant, would you consent to having theCommunity Services Directorate follow-up with you on the outcomes of the Grant,to hear how receiving the funding has supported you and/or your family?○ Yes○ No

If yes, would you also be interested in being involved in a short case study and/ora de-identified story about your experience and the benefits the Grants have hadon you and/or your family to be published to the Canberra community as part offuture promotion rounds?○ Yes

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○ No

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2020-21 Tenant Participation Grant (TPG) Application Form ... · the kind of support applicants may...

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