BLCF – Grant Application Form

How did you hear about us?

Parent/Carer 1

Relationship to the child

Financially responsible for the child

First Name

Last Name

Date of Birth

Age

Gender

Street and Number

Suburb

State

Postcode

Is the child a refugee?

Is the child of Aboriginal or Torres Strait Islander heritage?

Main language spoken at home

Diagnosis or condition Impact on daily life Current supports Impact on family Current therapies

Is your child an NDIS participant? *

If no, why not? * Child’s therapy goals *

NDIS plan or goals *

Up to 5 files. Max 10 MB each. Accepted: PDF/JPG/PNG/WEBP/HEIC.

What allied health services do you require? * Impact if grant is not received * Diagnosis letter (optional)

Up to 5 files. Max 10 MB each. Accepted: PDF/JPG/PNG/WEBP/HEIC.

Additional documentation (optional)

Up to 5 files. Max 10 MB each. Accepted: PDF/JPG/PNG/WEBP/HEIC.

Do both parents/carers live in the same household?

Receive news updates

I agree to the Privacy Policy and terms

I declare the information is correct

I agree to complete the final survey/report

I give permission for image use

Your application has been received. We'll be in touch soon.

If you have any questions, feel free to contact us at info@blcf.org.au.