2018 National Disability Conference Funding Support Application Form 2018 DSS Funding Support Application Form Disability Conference Funding Support is made available from the Commonwealth Department of Social Services’s National Disability Conference Initiative administered under the Disability, Mental Health and Carers Programme. The purpose of the grant is to help offset the financial cost to self-funded individuals with a print disability wishing to attend the annual Round Table conference. All applicants seeking a portion of the funding support made available by this grant must be an Australian resident and complete and lodge this form on or before 23 February 2018. NOTICE FOR JAWS SCREEN READING SOFTWARE USERS There is a recognised problem between JAWS and Internet Explorer that causes the word "region" to be spoken on each form field, immediately before the field name is spoken (such as First, Last, E-mail etc). If you find this annoying try setting JAWS Verbosity to “advanced” or use a different browser.YOUR CONTACT DETAILSName* First Last Email address and confirmation of email address* Enter Email Confirm Email Postal address (line 1)*Postal address (line 2)Town/City*State/Province*Postcode*Country*Preferred phone number*Including area code, where applicable.Alternative phone numberIncluding area code, where applicable.ACCESSIBILITY REQUIREMENTSDo you have a print disability?*What are your accessibility requirements?Please note: Accessibility requests may not be able to considered after 23 February 2018. CONFERENCE ATTENDANCEThe Round Table conference commences with the Australian Braille Authority meeting on Saturday with conference presentations delivered on Sunday, Monday and Tuesday.For how many days do you intend to register for the conference?*Please Note: Funding may be granted based on number of days attendance and could alter if registration details are not the same as information provided in this form. ESTIMATE OF EXPENSESIf your application is successful funding may be provided to assist with the costs of travel, registration and accommodation expenses. Other expenses cannot be considered.Please provide an estimate of your travel expenses.*eg. airfares, taxis, trainsPlease provide an estimate of your accommodation expenses.*Please provide an estimate of your registration expenses.*Please provide a total for all of above expenses.*Have you sought funding from other sources, such as your employer or other grant-making body? If so please provide details.*ADDITIONAL INFORMATIONPlease provide any additional details that you would like Round Table to consider when assessing your application.eg. Are you a conference presenter? Are you a first time attendee?DECLARATIONI declare that the information given in this form is true and correct.* check this box to accept the declaration. Once you have submitted your application please do not close your browser until you receive an acknowledgement message.