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Personal Details (Not Applicable)

Organisation * Required

Applicant Name * Required

Title

First name

Last name

Applicant Role * Required

Organisation Address * Required

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Address line 1

Address line 2

Suburb/Town

State/Province

Postcode

Country

Address Line 1, Suburb/Town, State/Province, Postcode, and Country are required.

Applicant Primary Phone Number * Required

Must be an Australian phone number.

Applicant Primary Email * Required

Must be an email address.

Sport / Impairment (Not Applicable)

What are the eligible health conditions of the athletes who will use the equipment requested? Multiple options can be selected * Required

Response required.Response required.

Impaired Muscle Power (i.e. complete or incomplete spinal cord injury, spina bifida, muscular dystrophy)

Impaired Passive Range of Movement (i.e. arthrogryposis, joint contracture)

Limb Deficiency and/or Limb Length Difference (i.e. amputation, congenital limb deficiency, dysmelia)

Short Stature (i.e. achondroplasia, growth hormone dysfunction, osteogenesis imperfecta)

Coordination Impairments: Hypertonia, Motor Ataxia, Dyskinesia (i.e. cerebral palsy, traumatic brain injury, stroke, multiple sclerosis)

Vision Impairment (i.e. retinitis pigmentosa, rod cone dystrophy, diabetic retinopathy)

Intellectual Impairment (i.e. have restriction in intellectual functioning & adaptive behavior which effects conceptual, social and practical skills required for everyday life)

Other:

Clear the selected value for What are the eligible health conditions of the athletes who will use the equipment requested? Multiple options can be selected

Summer Para Sport (If Applicable)

Blind Football

Boccia

Goalball

Para Archery

Para Athletics

Para Badminton

Para Canoe

Para Climbing

Para Cycling

Para Equestrian

Para Judo

Para Powerlifting

Para Rowing

Para Swimming

Para Table Tennis

Para Taekwondo

Para Triathlon

Para Shooting

Sitting Volleyball

Wheelchair Basketball

Wheelchair Fencing

Wheelchair Tennis

Wheelchair Rugby

Clear the selected value for Summer Para Sport (If Applicable)

Winter Para Sport (If Applicable)

Para Alpine Skiing

Para Biathlon

Para Ice Hockey

Para Nordic Skiing

Para Snowboard

Wheelchair Curling

Clear the selected value for Winter Para Sport (If Applicable)

Decribe the athletes that will be impacted by the equipment requested (number of athletes, level of competetion, para sport involvement, categorisation etc.) * Required

Must be no more than 300 characters.

Round: Para Sport Equipment Enhancement Program - Stream 3 or 4 (Programs) - December + January

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Personal Details (Not Applicable)

Sport / Impairment (Not Applicable)

Grant Information

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