You can be assured that all information that you provide is treated confidentially.
Please note, by typing your name you are consenting to sharing your information with Sleapy’s Foundation review committee.
For more information on our
Privacy Policy , please visit
our policy
here on our website.
We appreciate that this is a stressful time, so will endeavour to consider your application and
provide you with an outcome as soon as possible.
If you require any additional support to complete your application or have any questions,
we’re here to help.
Please contact Robynn Sleap on 0423 956756 email
[email protected] or
Scott Pfeiffer on 0414 562103, email
[email protected] for
assistance.
Person (s) Initiating Application
Email
Phone
Address
Relationship to Person requiring assistance:
Person (s) Requiring Assistance
Email
Phone
Address
Date of Birth:
Please provide details of your current situation:
Provide a brief history of Illness / adversity along with short and long term outcome scenarios.
Have you received any assistance from charitable or other organisations previously? If yes, please provide details including amounts received and purpose.
Please state how assistance from Sleapys Foundation will benefit the applicant or person requiring assistance and detail what kind of assistance Is required, e.g., direct funding, counselling, respite etc.
Please be very specific with the purpose and the amount(s) required as this will assist us in making a decision.
File upload
Please see the
guidelines here to assess your application before submitting.
I understand that by giving my consent, Sleapys Foundation may use the photograph, video
or audio recording taken of me. The Foundation may reproduce the image/s in any form, in
whole or in part, and distribute the works by any medium (including online, social media,
direct mail, flyers, publications, case study, newsprint and multimedia) for the purposes of
education, promotion, fundraising and marketing.
I understand that the Foundation will not pay me for giving this consent or for the use of my
image(s), may keep the image(s) on record until I revoke my consent, will return or destroy
images if I withdraw this consent (with the exception of those already published), may use
the image in the future unless I specify limitations for its use and will not infringe the rights of
any third party by exercising its rights given in this consent.
I give consent to the Foundation to make, use and/or retain an image(s) that may identify
me, my child or an individual for whom I have authorised decision-making
responsibility.
I understand that I can withdraw or modify my consent at any time in writing
to
Sleapys Foundation,[email protected]
Application Date
Send Request For Assistance
