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Online Grant Application – The Leonie Jackson Memorial Fund
Personal Details
Name
(Required)
First
Last
Are you applying as: [please tick]
(Required)
An individual
An organisation
A community group
A school
Name of your organisation, community group or school [if applicable]:
Address
(Required)
State / Province / Region
ZIP / Postal Code
Preferred Communication Style
(Required)
Video call
Video message
Email
Text
Voice call
Email
(Required)
Phone
Mobile Phone (SMS)
Are you (please tick):
(Required)
Deaf
Hard of hearing
Hearing
Project Details
You can choose how to respond to questions. You can upload a video here [maximum file size: 2GB] or on a platform [i.e. YouTube, Vimeo] and provide the link below. You can also choose to write your response in text form.
What is your project?
[5 minutes Auslan video or 500 words max]
Upload a video
Max. file size: 2 GB.
Link to a video
English response
How will your project support bilingual education for deaf children?
[3 minutes Auslan video or 300 words max]
Upload a video
Max. file size: 2 GB.
Link to a video
English response
How does your project incorporate Leonie’s favourite mantra, ‘it takes a village to raise a child’?
[ 3 minutes Auslan video or 300 words max]
Upload a video
Max. file size: 2 GB.
Link to a video
English response
How can your project be scaled up and/or replicated?
[ 3 minutes Auslan video or 300 words max]
Upload a video
Max. file size: 2 GB.
Link to a video
English response
What is the timeline for your project?
[ 3 minutes Auslan video or 300 words max]
Upload a video
Max. file size: 2 GB.
Link to a video
English response
Funding
Allocation of requested funds
(Required)
Item Description
Cost
Add
Remove
Please enter details of what you will use for and how much each item will cost
Total funds requested
(Required)
Please provide the total dollar value of your request.
Have you applied for funds from other sources for your project? If yes, please detail
Item Description
Cost
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Remove
Applicant Declaration
Applicant Declaration
(Required)
I declare that to the best of my knowledge all the information in this application is true and correct.
(Required)
Applicant Declaration
(Required)
I have included all the necessary documentation and satisfied all criteria required to properly evaluate my suitability for a grant as per the criteria available from Deaf Connect.
(Required)
Applicant Declaration
(Required)
I agree to sign a Terms of Agreement document.
(Required)
Name
First
Last
Date
DD slash MM slash YYYY
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