Counselling Support Group Application

Can you please send me the following information so that I may apply for funding from Carers NSW on your behalf: - (Your personal details will not be used for anything except statistical data for the purposes of Carers NSW solely).

You will need to agree to the following statement: - (I consent to my details being passed on to Carers NSW.)
Yes

Name

Address

Phone/Mobile
(no spaces)

Date of Birth
(dd/mm/yy)

Occupation

Country of Birth

Do you identify as an
Aboriginal or TSI person?

Yes
No

Child Name

Child Age

Child Gender

Child's Country of Birth

Is Child Aboriginal or TSI?

Yes
No

Do you live with the
person you care for?

Can you also send me a short description of your caring role and your reason for attending the group?

Please be advised there is a fee of $30 per week ($240 in total) for this group, some reductions may apply, phone to discuss your circumstances. In the event you are not able to make one of the 8 sessions the fee still applies. Please inform me by email or phone of any weeks you are not able to attend in advance.

Description

Group location

Group session

Group 1: 9.30am - 11.30am
Group 2: 12.30pm - 2.30pm

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