EOI application form - Individual

Aboriginal Facilitator and Educator - cultural safety training

Please note, when completing the online form your progress will not be saved if you close the window or refresh the page. We recommend completing the application in one session.

Section A1 - Applicant details for individual

Name

Phone

Facilitator biography (500 words max)

Section B - Assessment criteria

Section C - Budget proposal

How much funding are you applying for?

Note: Check the EOI for the range of funding available based on the region you are applying for.

How many sessions will you be able to deliver based on the funding you are applying for?

Note: If applying for just one region (northern or southern) the minimum sessions is four. If applying for the entire COORDINARE catchment, the minimum sessions is eight.

Please use the below space to provide any additional information about the amount you have requested - for example breakdown of accommodation, travel expenses, direct delivery cost etc.

Section D - Additional information

Shortlisted applicants may be asked to participate in a yarn if deemed necessary to make a final decision on the preferred applicant. To assist with scheduling, please indicate your availability between 14-19 December 2025.

If you are the successful applicant is there anything you would need from COORDINARE to help make this a safe and meaningful experience for you and the community? If yes, please make a note below.

Section E - Declaration

This must be completed by the individual submitting the application:

If this application is successful, I am committed to participate in the project within the designated time frame.

If this application is successful, I agree to provide required payment document (including invoice and paid participation form) to COORDINARE – South Eastern NSW PHN.

I understand and accept the Terms and Conditions of the Expression of Interest, as outlined in the EOI guideline.

I understand and accept that information provided in this application may be stored by COORDINARE – South Eastern NSW PHN in various hardcopy and/or electronic formats.

I understand that this application does not create a legal or binding commitment and that if successful I will be bound by a contract with COORDINARE - South Eastern NSW PHN.

I can confirm that the contents of this application are to the best of my knowledge accurate, complete and do not contain any false, misleading or deceptive misrepresentation, claims or statements.

I understand that if the conditions of the funding are not complied with, COORDINARE – South Eastern NSW PHN may seek to recover any funds allocated.

If my application is successful, I agree to provide a valid National Police Check and any other compliance documentation as requested by COORDINARE – South Eastern NSW PHN.

Note: If you submit your application via video, it’s understood that you have read and accepted the above under Section D. Declaration.

Applicant signature

Full name

Date