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Application for preschool funding

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Applicant details

This application is lodged by:

Entity's ABN *

Entity name * (as per ABN)

Approved provider number issued by the Education Standards Board (ESB) *

PR-

Street address

Number and street name *

Suburb *

Postcode *

• Postal address is the same as residential

Postal address

Number and street name

Suburb

Postcode

Details of contact person:

Name *

Email *

Phone

Mobile

Service provider details

Service approval number issued by the ESB *

SE-

Name of service * (as per Certificate of Service Approval)

Street address

Number and street name *

Suburb *

Postcode

Phone * (business hour)

Email *

Estimated number of children that will be enrolled in your preschool program *

Goods and Services Tax (GST)

To enable the allocation of grant funds, the Department for Education will generate a tax invoice on behalf of the funding recipient and forward payment and copy of the tax invoice to the recipient. This process can only occur if the recipient has a current ABN and is registered for GST.

Is your organisation registered for GST? *

• Yes
• No

Certification

The accuracy of information provided above must be certified below:

I, *

certify that, as far as I am reasonably aware, the information provided in the Application for Funding is true and correct and, that the applicant:

• will comply with terms and conditions of Funding Agreement and
• if requested by the department, will provide documentary evidence in relation to the Application for Funding.

Position of authorised officer *

Date *

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