Parkinson’s Support Fund – Application Form (Pilot Phase)

The Parkinson’s Support Fund (PSF) provides short-term, limited assistance to people with Parkinson’s disease who have been assessed as eligible for My Aged Care and/or NDIS funding but are experiencing a delay or gap in accessing funded supports.

PSF is currently operating in a pilot phase with limited capacity.
Submission of this application does not guarantee assistance.
All applications are assessed by the Client Advisory Board (CAB) against agreed eligibility and equity criteria.
Any support offered is time-limited and subject to review.

Applications without supporting documentation confirming funding eligibility will not be assessed.

SECTION 1: Applicant & Participant Details

Person with Parkinson’s – First Name *

Person with Parkinson's - Last Name *

Date of Birth *

Primary Contact PersonIf different from the person with Parkinson’s

Phone Number *

Email Address *

SECTION 2: Diagnosis & Care Context

Parkinson’s Diagnosis Summary *Please include year of diagnosis and any major interventions (e.g. Deep Brain Stimulation).

Current Living Situation *Please briefly describe who the person with Parkinson’s lives with and what day-to-day support is available.

Treating GP or Specialist DetailsName, practice, and phone number (if known). If not currently assigned, please write “Not currently assigned”.

SECTION 3: Funding Application Status (Mandatory)

Which funding scheme have you applied for? *

Date of the Government application *

Funding Reference Number(s) *Please provide your My Aged Care ID or NDIS reference number.

Funding Eligibility Status *Applications may be deferred until eligibility has been confirmed through a completed assessment.

SECTION 4: Request for Support

What type of support are you seeking from the Parkinson’s Support Fund? *

Neuroactive / exercise classesSupervised gym access1:1 allied health therapyShort-term structured program

Why is support required at this time? *Briefly outline the impact of the funding gap and the risks of waiting for funding to commence.

SECTION 5: Supporting Evidence (Required)

Upload Supporting Documentation *

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Please upload at least one of the following: • My Aged Care eligibility letter (including package level) • NDIS plan or eligibility confirmation • Assessment outcome letter confirming eligibility • Funding correspondence showing approval with delayed commencement. Applications without documentation will not be assessed.

I declare that the information provided in this application is true and correct to the best of my knowledge. I consent to The Parkinson's Support Fund collecting and using my personal and health information for the purpose of assessing this application.
I authorise the Fund, if required, to contact my nominated GP or Specialist solely to verify information provided in this application. I understand that submission of this application does not guarantee assistance and that any support offered is limited in scope, time-bound, conditional and subject to review by the Client Advisory Board.
*

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