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AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
AACCC © - Waiting List Application / Childcare Forms | 1
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
WAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATIONWAITING LIST APPLICATION
Child’s full name: Child’s full name: Child’s full name: Child’s full name: Date of birth: Date of birth: Date of birth: Date of birth:
Parent contact detailsParent contact detailsParent contact detailsParent contact details
Mother’s name: Father’s name:
Address: Address:
Home phone: Home phone:
Mobile phone: Mobile phone:
Work phone: Work phone:
Email: Email:
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Employment Status:Employment Status:Employment Status:Employment Status: please circleplease circleplease circleplease circle
Working/Studying/Home duties
Full Time or Part Time
Required days Required days Required days Required days of careof careof careof care
� Monday � Tuesday � Wednesday � Thursday � Friday
Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:Care to commence on (date) pending availability of positions:
Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):Name/s of siblings currently in care (if applicable):
Does your child have any special needs?Does your child have any special needs?Does your child have any special needs?Does your child have any special needs? Yes/No
Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities?Do you have any special needs/disabilities? Yes/No
Aboriginal or Aboriginal or Aboriginal or Aboriginal or TorresTorresTorresTorres Strait Islander?Strait Islander?Strait Islander?Strait Islander? Yes/No
LanguagesLanguagesLanguagesLanguages spoken at home?spoken at home?spoken at home?spoken at home?
Signature of applicant:Signature of applicant:Signature of applicant:Signature of applicant:
Date of application:
Notes:Notes:Notes:Notes:
AACCC © - Waiting List Application / Childcare Forms | 2
ARABIC AUSTRALIAN CHILD CARE CENTRE
48484848----50 Taylor Street50 Taylor Street50 Taylor Street50 Taylor Street, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195, Lakemba NSW 2195
PO Box 130PO Box 130PO Box 130PO Box 130,,,, Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195Lakemba NSW 2195
Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256Phone: 02 9758 2256 Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846Fax: 02 9750 0846
Email: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.aEmail: aaccc@tripolimena.org.auuuu
Office use onlyOffice use onlyOffice use onlyOffice use only
Priority of access assessmentPriority of access assessmentPriority of access assessmentPriority of access assessment (as per A New Tax System (Family Assistance) Act 1999):
� Priority 1: a child at risk of serious abuse or neglect
� Priority 2: a child of a single parent who satisfies, or of parents who both satisfy, the work/training/study test
under Section 14 of the A New Tax System (Family Assistance) Act 1999 (see notes below)
� Priority 3: any other child
Additional informationAdditional informationAdditional informationAdditional information (within these priority categories, precedence should also be given to children in:
� Aboriginal and Torres Strait Islander families
� Families which include a person with a disability
� Families on lower incomes
� Socially isolated families
� Single parent families
Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:Notes for Priority 2:
An individual is recognised to be in work or work related commitmentswork or work related commitmentswork or work related commitmentswork or work related commitments if they:
• Are in paid work (for at least 15 hours per week)
• Receive a carer payment under Part 2.5 of the Social Security Act 1991, or
• Receive a carer allowance for a disable adult as per section 952 of the Social Security Act 1991
An individual has recognised training commitmentsrecognised training commitmentsrecognised training commitmentsrecognised training commitments if undertaking a training course (for at least 15 hours per
week) for the purpose of improving work skills and/or employment prospects, including during course vacations.
An individual has recognised study commitmentsrecognised study commitmentsrecognised study commitmentsrecognised study commitments if:
• Receiving a youth allowance and undertaking full-time study (at least 15 hours per week)
• Receiving Austudy payment under the Social Security Act 1991
• Receiving a pensioner education supplement under the Social Security Act 1991
• Receiving assistance under the ABSTUDY scheme, or
• Undertaking any other education course (for at least 15 hours per week) for the purpose of improving
work skills and/or employment prospects, including during course vacations.
Source: Sections 14-17A of ‘A New Tax System (Family Assistance) Act 1999’
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