'Expert Connection' - Application Form

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* 1. Business Name

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* 2. Australian Business Number (ABN)

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* 3. Business Sector

Accommodation & Food Services (including cafes and restaurants)

Admin & Support Services

Agriculture Forestry & Fishing

Arts & Recreation

Construction

Education & Training

Electricity Gas Water & Waste

Finance & Insurance

Health Care & Social Assistance

Information Media & Telecommunications

Manufacturing

Mining

Professional Scientific & Technical

Public Admin & Safety

Rental Hiring & Real Estate

Retail

Transport Postal & Warehousing

Wholesale

Other (please specify)

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* 4. Business Address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

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* 5. Local Government Area

City of Mount Gambier

District Council of Grant

Kingston District Council

Naracoorte Lucindale Council

District Council of Robe

Tatiara District Council

Wattle Range Council

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* 6. Number of Employees

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* 7. Business turnover in 2019-20

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* 8. How has your business been affected by Government COVID-19 restrictions?

Temporary closure due to Government restrictions (now open)

Continued closure due to Government restrictions (still closed)

Reduced operation due to Government restrictions

Limited impact due to Government restrictions

No impact due to Government restrictions

Other (please specify)

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* 9. Has your business been able to access financial Government support?

JobKeeper

$10,000 South Australian Emergency Cash Grants

South Australian Business and Jobs Support Fund

JobSeeker

Small Business Loan Repayments Deferred

Have not accessed Government support

Other (please specify)

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* 10. Please indicate on the list below the type of expert assistance your business is seeking:

Business planning (including planning for future impacts of COVID-19)

IT support – website development, eCommerce sales platforms, cyber security

Bookkeeping

Accounting – tax support, cash flow planning, budgeting

Marketing, branding and social media

HR and staffing

Legal advice

Workplace Health and Safety

Mental health and wellbeing support

Other (please specify)

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* 11. Please describe the issue/s your business is currently facing and how the expert help selected on Q10 can assist.

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* 12. Contact Details of Person Completing the form

Name

Role within Business

Phone Number

Email Address

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* 13. Confirmation

I confirm that I have read and understood the Program Guidelines

I understand that completing this application form does not guarantee access to the Expert Connection Program. RDALC will make contact to discuss eligibility status and seek further information if required.

I meet and can provide evidence as to my eligibility for the program