Individual Information

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* 1. Details of the Individual applying

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* 2. First Name

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* 3. Surname

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* 4. Address

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* 5. Main phone number

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* 6. Email address

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* 7. Are you a full time student?

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* 8. Do you hold a Health Care or Disability Support Pension (DSP) card?

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* 9. Are you a Service User/Volunteer? (Service user or volunteer providing input into service delivery of a QCOSS member organisation who participate in service development)

  Yes/No
A service user of a QCOSS member organisation
A volunteer of a QCOSS member organisation 

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* 10. Organisation name and member number (if applicable)

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* 11. Organisation address (if applicable)

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* 12. Organisation main phone number

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* 13. Are you unwaged?

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* 14. Are you a QCOSS member?

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* 15. Name of course/event

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* 16. Date of event

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* 17. Why do you need a subsidised place? (address criteria/priorities where possible)

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* 18. Why would attending this course be valuable to you?

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* 19. Other comments to support your case

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* 20. You have read the terms of the QCOSS event subsidy program and agree to the cancellation policy

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* 21. Signed by training applicant

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* 22. Approved and signed by CEO or senior person

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