Pathways to Resilience Trust Application Form – Schools

Your Name:

Your Position:

Name of School:

Street Address

Street Address 2

State
QLDNSWVICSANTTASWAACT
Post Code

Postal Address

Postal Address 2

State
QLDNSWVICSANTTASWAACT
Post Code

Phone 1

Phone 2

Fax

Email (required)

Number of children currently enrolled:
Background: Does the community you serve identify with any of the following?
 Non-English Speaking Background Disability Aboriginal / Torres Strait Islander Isolated / Rural Socio-economically disadvantaged Drought affected area Culturally and linguistically diverse
Other
Approximate breakdown of ethnic background of student population:


Does your organisation currently run any similar programs (e.g. resilience or social skills programs)?
 Yes No

If Yes, which program(s)?


How do you intend to supply workbooks for your students (please request a price list for the discounted workbook prices)?
 1. Apply for grants/funding for this purpose 2. Use existing funding 3. Add to booklist/give families the option of purchasing
4. Other (please specify)

What year level(s) do you intend to run the program with?

When do you intend to commence implementation of the program?

Would you like to apply for:
 Option 1: Staff in-service Option 2: Staff to attend workshops

If you are applying for Option 1, please answer the following questions:

Which program(s) would you like your staff trained in?
 Fun Friends (4-7 years) FRIENDS for Life (Child: 7-12 years) FRIENDS for Life (Youth: 12 – 17 years)

What are your preferred dates for the in-service?

Would you be willing to collaborate with surrounding schools / organisations to participate in the training workshop (please specify)?
 Yes No

How many participants do you estimate would be in attendance at the workshop?

Are you able to provide:

1. Venue?  Yes No

2. Data projector?  Yes No

3. Laptop?  Yes No

If you are applying for Option 2, please list the name(s), position(s) and preferred training dates of staff who wish to attend (see Events page).


Why do you think your school community would benefit from these programs?


Questions/comments?


Form submitted by Of school
Date
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