MAC Early Intervention Support Referral (SA only)

MAC refers to Ministerial Advisory Committee and is a sub-set of funding through the South Australian Department of Education under the Children and Students with Disability Program Grants for non-government organisations.

Funding is administered on behalf of the Minister for Education by the Ministerial Advisory Committee: Children and Students with Disability (MAC:CSWD), and is part of the SA State Government education funding grants.

The Benevolent Society currently provides MAC:CSWD funded services to a range of Early Learning Centres, Pre-schools and Kindergartens across metropolitan Adelaide, and in regional towns located in proximity to our offices in Port Pirie, Murray Bridge and Mount Gambier.

If you have or know a child with a disability who would benefit from assistance, please complete this referral form. You may download and email the paper based version to customercare@benevolent.org.a u or complete the digital form below.

To know how we collect, use and store your personal information, please see our Privacy Collection Notice.

Student Details

Student details

Name* - required

Identification number (if known)

Date of birth (Must be 2 years or over):

School/Preschool/Kindergarten/Childcare site* - required

Gender* - required

Male Female Non-Specific

Cultural Identity* - required

Does the child identify as Aboriginal and/or Torres Strait Islander?* - required

Yes No Prefer not to say

Is the client an NDIS participant? If yes, they are not eligible for MAC funding but can receive our services via NDIS. For an NDIS and all referral information please contact the TBS Support Centre (1800 236 762) or Email: customercare@benevolent.org.au

Referrer Details

Referrer details

First Name* - required

Contact Number* - required

Email Address* - required

I have authority to consent, refer and share this child's information with The Benevolent Society* - required

Yes No

Signature

Please type your signature

Please sign here

Date

Endorsement

This application has been completed by (ENTER YOUR NAME)* - required

I am a* - required

Parent Caregiver Educator

A copy of this referral, signed by the parent/caregiver, is stored securely at the school (if applicable).* - required

Application endorsed by school Principal/Director/Caregiver (Authorizing person of site if applicable)* - required

I have read the privacy collection notice below and consent to The Benevolent Society contacting me regarding disability support services.* - required