GCHHS Support FY24-25

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1. GCHHS Support Application(Not Applicable)

GCHHS Support Application

* indicates a required field.

Applicant *

Organisation Name
Response required. Individual Organisation Clear the selected value for Applicant

Title	First name	Last name

Applicant Position *

Applicant Primary Phone Number *

Must be an Australian phone number.

Applicant Primary Email *

Must be an email address.

Applicant Department *

Program Details (Not Applicable)

Program Title *

How did you identify the need for this item / program? *

How many staff will be involved in the program? *

Must be a number.

How many patients will be involved with the program? *

Must be a number. If only staff are involved enter 0

What is the expected outcome/impact across the Hospital or Community from the program/event? *

Frequency for funding request *

Response required.

Annual Event / Program

One off application

Possible further requests this Financial Year

Clear

If Annual Event / Program a new application will be required for the next Financial Year

This section is not applicable because of your response to question: "Frequency for funding request" on page 1

If possible further requests please state estimated amounts and frequency *

Example: Item to be replaced / upgraded in 6 months due to regular use. Same quantity as this application and same cost

Estimated Date of Event / Program for this funding (DD/MM/YYYY)

Budget (Not Applicable)

Expenditure	$

Must be at least 2 rows

Budget Totals (Not Applicable)

Total Amount Requested *

This number/amount is calculated.

Attach 3 quotes for programs over $3,000 (min 2 quotes for all other amounts) (Not Applicable)

First Quote *

Attach a file:

Second Quote *

Attach a file:

Third Quote

Attach a file:

Authorisation (Not Applicable)

Upload declaration form. Click here to download the declaration form to be signed by both the applicant and Department Director.

Upload once authorised *

Attach a file:

Authorisation form to be signed: