Expression of Interest - Consulting and community facilities

Privacy statement

Early Learning Victoria collects this information to assess your organisation’s suitability for program delivery at our centres. We will handle the information in accordance with our Privacy Policy and use it only for this purpose.

If you are completing this form on behalf of someone else or nominating another person as the organisational representative, make sure they know their contact details have been shared. They may be contacted regarding this Expression of Interest.

About you and your organisation

Organisation type(Required)

Not-for-profit -- An organisation which provides services to the Community, consisting of primarily paid staff and returns all profits into the operation of the organisation to carry out its purposes

Community -- A not-for-profit organisation that exists exclusively for charitable purposes or as an amateur sporting group, arts, craft or other special interest group established for the benefit of the community. Primarily voluntary staff and/or committee.

Commercial -- Tenancy by an organisation which is operating for the profit or gain of its individual members, both directly and indirectly.

Private -- A group or individual with no incorporated or registered status.

Organisation name(Required)

ABN/Incorporated number

If applicable

Contact person(Required)

Phone(Required)

Mobile

Email(Required)

Website

Street address

Street address(Required)

Street address line 2

Suburb(Required)

Postcode(Required)

Service/program information

Which Early Learning Victoria centre are you interested in using?(Required)

Which space do you require?(Required)

Select one.

Community room

Maternal and Child Health/consulting room

What age groups does your service target?(Required)

Who does your program specifically target?(Required)

Provide details. For example: Children, parents, families, people living with disability, newly arrived migrants, Aboriginal or Torres Strait Islander people, Culturally and Linguistically Diverse (CALD) communities.

If other, please specify

Is your organisation currently using other Early Learning Victoria facilities?(Required)

Yes

If yes, please specify

Preferred days and times(Required)

For example, Mondays 9-5

Does your service run all year round?(Required)

Yes

Have you been made aware of and do you agree to Early Learning Victoria’s consulting and community facilities fee structure?(Required)

Yes

Authorised delegate declaration

If any of the above do not apply, list them here:(Required)

Important email