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Home
About Us
Support
- Patient
- Health Professionals
Education
- School Presentations
- Community Engagement
News
- Awareness Days
- Newsletter
Get Involved
Youth Hub

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Name *

Home Address *

Email Address *

Contact Phone Number *

Are you applying as: (please tick where appropriate) *

A patient with a genetic blood condition.
A carer of a patient with a genetic blood condition.

Please specify what item(s) you are seeking to fund. *

Which hospital or treatment centre do you attend? *

Who will primarily benefit from this funding: (please tick where appropriate) *

Adult patients with haemoglobinopathies.
Young patients with haemoglobinopathies.
Parents and/or carers of patients with haemoglobinopathies.

Please specify how patients/carers will benefit from this funding request? *

Approximately how many people will benefit from this? *

Please outline how you have established a need for the item(s) requested? *

Do you have approval from the hospital/treatment centre to procure the item(s) for which you are seeking funding? (Please tick where appropriate) *

Yes
No
Am currently seeking approval.
Not applicable

Please indicate (to the nearest dollar) how much funding you are seeking? *

Have you explored other sources of funding for the item(s) you are requesting? *

Yes
No

If yes, please provide details and also indicate whether there is potential for TASCA *

Please provide 2 quotes for the item(s) you are seeking. *

Please provide any other supporting documents (eg. letters of support, petitions, evidence of benefit, evidence of need). *

Click or drag files to this area to upload. You can upload up to 4 files.

Please add any further comments to assist us in our funding allocation

Thalassaemia and Sickle Cell Australia (TASCA) is a support and advocacy organisation for Australians living with genetic haemoglobin conditions.

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