Application questions

To assist with completing your applications for the 2018 Disability and Inclusion Program, the questions that need to be completed on ECCMS have been provided below.

Child Application (for high learning support needs or emergency funding)

Page 1 – Child Details

CHILD DETAILS

  • First Name:*
  • Last Name:*
  • Gender:*
  • Date of Birth:*
  • Child's Residential Postcode:*

Page 2 – Disability

DISABILITY APPLICATION DETAILS

Type of disability:  *

Options in drop-down list include:

  • Multiple Disability
  • Achondroplasia
  • Acquired Brain Injury
  • Agenesis of Corpus Callosum
  • Alagille Syndrome
  • Angelman Syndrome
  • Apert Syndrome
  • Arthrogryposis
  • Autism Spectrum Disorder
  • Bardet-Biedl Syndrome
  • Brachmann de Lange Syndrome
  • CHARGE Syndrome
  • Cerebral Atrophy
  • Cerebral Palsy
  • Charcot-Marie-Tooth Syndrome
  • Chromosomal Disorder
  • Cornelia de Lange Syndrome
  • Costello Syndrome
  • Craniofacial Disorder
  • Cri du Chat Syndrome
  • Crouzon Syndrome
  • Dandy-Walker Syndrome
  • Developmental Delay
  • DiGeorge Syndrome
  • Down Syndrome
  • Ehlers-Danlos Syndrome
  • Encephalopathy
  • Erb Palsy
  • Foetal Alcohol Syndrome
  • Foetal Valproate Syndrome
  • Fragile X Syndrome
  • Friedreich Ataxia
  • Global Developmental Delay
  • Goldenhar Syndrome
  • Guillain-Barre Syndrome
  • Hearing Impairment
  • Hemiplegia
  • Hirschsprung Syndrome
  • Holt-Oram Syndrome
  • Hunter Syndrome
  • Hurler Syndrome
  • Hydrocephaly
  • Hypertonia
  • Hypotonia
  • Intellectual Disability
  • Jacobsen Syndrome
  • Joubert Syndrome
  • Kabuki Syndrome
  • Klinefelter Syndrome
  • Klippel-Feil Syndrome
  • Landau-Kleffner Syndrome
  • Langer-Giedion Syndrome
  • Laron Syndrome
  • Larsen Syndrome
  • Leigh Syndrome
  • Lissencephaly
  • Macrocephaly
  • Maffucci Syndrome
  • Marfan Syndrome
  • Melnick-Fraser Syndrome
  • Metabolic Disorder
  • Microcephaly
  • Mucopolysaccharidoses or Mucolipidoses
  • Muscular Dystrophy
  • Neurodegenerative Disease
  • Neurofibromatosis
  • Neurological Disorder
  • Noonan Syndrome
  • Ohdo Syndrome
  • Opitz G/BBB Syndrome
  • Oral Facial Digital Syndrome
  • Osteogenesis Imperfecta
  • Others
  • Paraplegia
  • Pervasive Developmental Disorder
  • Physical Disability
  • Pierre Robin Syndrome
  • Prader-Willi Syndrome
  • Proteus Syndrome
  • Quadriplegia
  • Rett Syndrome
  • Rubinstein-Taybi Syndrome
  • Russell-Silver Syndrome
  • Schizencephaly
  • Severe Behavioural Disorder
  • Severe Language Disorder
  • Severe Social/Emotional Disorder
  • Shprintzen Syndrome
  • Smith Magenis Syndrome
  • Soto Syndrome
  • Spastic Diplegia
  • Spina Bifida
  • Spinal Muscular Dystrophy
  • Sturge-Weber Syndrome
  • Tay-Sachs Disease
  • Tourette Syndrome
  • Townes-Brocks Syndrome
  • Traumatic Brain Injury
  • Treacher Collins Syndrome
  • Tricho-Rhino Syndrome
  • Trisomy 13
  • Trisomy 18
  • Trisomy 21
  • Trisomy 22
  • Trisomy 7
  • Trisomy 8
  • Tuberous Sclerosis
  • Turner Syndrome
  • Velo-Cardio-Facial Syndrome
  • Vision Impairment
  • West Syndrome
  • Williams Syndrome
  • Wolf-Hirschhorn Syndrome
  • XXX Syndrome
Evidence for Disability:*

There are two options provided for this question based on two types of high learning support needs applications. You only need to select one.

Page 3  - Enrolment

  • Enrolment Start Date:*
  • Enrolment End Date:*

ENROLMENT HOURS

  • Of the weeks your service is open this year, how many weeks is this child enrolled?: *
  • Use table to fill out a representative fortnight (Monday – Friday, Week 1 and Week 2) of:
    • Child enrolment hours
    • High learning support needs (HLSN) hours (enter the requested number of hours of support the child requires)

HIGH LEARNING SUPPORT NEEDS (HLSN) HOURS BREAKDOWN

  • Please indicate how you have calculated the hours of support this child requires, according to the program spending rules (see section 7.5 Spending Rules). (NOTE: The HLSN hours breakdown total should be identical to the HLSN total hours calculated above.)
    • How many HLSN hours above are estimated for additional staff per year?  *
    • How many HLSN hours above are estimated for activities related to development and delivery of the child’s Individual Learning Plan (ILP) per year?  *
    • How many HLSN hours above are estimated for professional development or anything else not listed above per year?  *

Page 4  - Summary

  • Confirmation required:  *
    • I confirm the preschool has written consent from the child's parent/carer to provide the details about this child contained within this application to the NSW Department of Education. This consent is held on the child's preschool file, and can be provided to the department upon request.

Child Application (for Minor Capital Works Applications)

Page 1 – Minor Capital Works

  • Confirmation required: Please confirm you have submitted or have an application in progress for high learning support needs (including emergency funding) for all children listed in this application.  *

MINOR CAPITAL WORKS DETAILS

  • Request Type: *
    • Equipment/Furniture
      • Enter Funding Amount Requested for Equipment/Furniture:
    • Minor Construction
      • Enter Funding Amount Requested for Minor Construction:

PROJECT DETAILS

  • Project Description:* (2000 character max.)
  • Question 1
    • Identifying inequitable access
      Briefly describe how the existing preschool facilities do not support the educational needs of the child/children in the application, and impede meaningful participation in the daily activities and routines of the preschool.* (2000 character max.)
  • Question 2
    • Promoting equitable access and meaningful participation
      Briefly describe how the proposed project will enable the child/children to access, and participate in, the educational program. (2000 character max.)
      In your response please include details of learning support needs and specific adjustments.*
  • Question 3
    • Links to Individual Learning Plan/identified needs
  • Briefly describe how the minor environmental adjustments and/or specialised equipment/furniture relate to Individual Learning Plan (ILP) outcomes or identified needs of the child/children.*

Page 2 – Supporting Information

CHILDREN INFORMATION

  • Please provide the full name and date of birth for all children this application relates to:* (2000 characters max.)

SUPPORTING DOCUMENTS

  • Please see Section 8.3 of the Disability and Inclusion Program guidelines for details of the required supporting documentation for your application. Please provide up to three quotes. If applying for equipment or furniture please provide photocopies or sample pictures from catalogues to support your application.
  • Add Document type:
    • Building Layout Plans
    • Request for Quotation
    • Furniture Catalogue Photocopy
    • Additional Documents
    • Project budget (including 5% contingency)
    • Others

Page 3 – Summary

Confirmation required: I confirm the preschool has written consent from the child's (or children's) parent/carer to provide details about the child (or children) contained within this application to the NSW Department of Education. This consent is held on file, and can be provided to the department upon request.  *

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