GRANT APPLICATION CRITERIA
This document (Grant Application Criteria) is the sole basis used by the Management Committee of the Gynaecological Cancer Society Inc. to determine its ability to provide grant funding to applicants.
Eligibility Requirements
An application may only be considered if it meets all of the following eligibility requirements
a) The application must directly concern those people described in the Object
b) The application must directly concern one or more of the six methods of assistance
c) The application must state clearly and specifically the nature and extent of the assistance required
d) Where financial assistance is requested, proof of indebtedness and subsequent payment receipts will be required
Brief, written applications may be submitted at any time and are subject to
prioritisation and the availability of resources. Applications may be resubmitted if resources are currently unavailable. All applications will be acknowledged and further information may be requested. All information will be treated in the strictest confidence.
FINANCIAL ASSISTANCE GRANT INFORMATION
Please read the following carefully. It contains important information relevant to the validity and success of an application for financial assistance from the Gynaecological Cancer Society
.
The attached Grant Application Form is valid for 1999 and is the only form upon which applications for financial assistance to gynaecological cancer
patients and their carers may be made.
As funding for this area of our work is very difficult to obtain, only those applications able to clearly demonstrate extreme financial distress caused directly by, or as a direct result of gynaecological cancer, are able to be considered.
Applicants must clearly demonstrate that they have made all reasonable efforts and taken all reasonable actions to overcome the cause or causes of their extreme financial distress before approaching the Society for a Financial Grant.
The Society's Grants Committee requests all potential applicants for financial assistance to critically evaluate their answers to the following questions:
- Is your extreme financial distress caused directly by, or as a direct result of gynaecological cancer ? YES / NO
- Have you spoken directly to your creditors or financiers requesting their assistance during this difficult period ? YES / NO
- Have you tried to obtain assistance through other recognised government and non-government support groups (local hospitals, community healthcare, community
aid, local service clubs, Queensland Cancer Fund) ? YES / NO
- Will a grant of up to $2,000 really have a significant effect on the cause of your extreme financial distress ? YES / NO
- The circumstances leading to your extreme financial distress have genuinely been beyond your control YES / NO
To proceed with this application for financial assistance, you must, after critical evaluation, have answered YES to all 5 questions. If you have answered NO to any of the questions, you may still wish to contact the Society for further advise and related assistance.
FINANCIAL ASSISTANCE GRANT APPLICATION FORM
a) Please answer all questions in full to the best of your ability. Our verification process is greatly assisted by the provision of contact names and telephone numbers.
b) It is necessary to provide appropriate documentary evidence to support your application.
c) When providing proof of indebtedness, payment receipts or letters supporting your application, please send only copies. Do not send originals.
d) We must reserve the right to corroborate the information contained in this application.
e) To assist in processing this application, please print your responses.
f) Applications are subject to prioritisation and the availability of resources.
g) All applications will be acknowledged and further information may be requested.
h) All information will be treated in the strictest confidence.
1 NAME OF APPLICANT -
2 ADDRESS -
3 TELEPHONE NUMBER - ( )
4 RELATIONSHIP TO GYNAECOLOGICAL CANCER PATIENT -
5 TYPE OF GYNAECOLOGICAL CANCER -
6 NAME OF LOCAL DOCTOR -
7 NAME OF CANCER SPECIALIST DOCTOR VISITED -
8 HOSPITAL/S VISITED -
9 WERE YOU A PUBLIC ...... INTERMEDIATE ...... PRIVATE ...... PATIENT ?
10 DO YOU HAVE PRIVATE HEALTH INSURANCE ? YES ...... NO ......
11 THE GRANT WILL BE USED FOR - (tick category & value)
- TRAVEL ...... $ .............
- ACCOMMODATION ...... $ .............
- MEDICAL PROCEDURES ...... $ .............
- HOSPITALISATION ...... $ .............
- REHABILITATION ...... $ .............
- EQUIPMENT ...... $ .............
- PATIENT WELFARE ...... $ .............
- CARER WELFARE ...... $ .............
- OTHER (please specify) ...... $ .............
12 TOTAL GRANT REQUEST - $ .............
13 REASON FOR GRANT REQUEST -
(Please state in 500 words or less the circumstances leading to your extreme financial distress; how those circumstances match our financial grants criteria and the significant benefit to be gained by you. Please use additional sheets as required)
Contact details:
