DAVID WILLIAMS FUND

51 Commercial Rd, South Yarra, 3141. 03 9863 0444

2026 Application for Financial Assistance (Subsequent)

The David Williams Fund provides support to improve the well-being of the Victorian HIV community. The average application is approximately $125. Not all applications are approved as demand on the Fund is high. The fund does accept applications for: medical expenses, emergency food vouchers, some appliances, education costs and basic needs items. The fund cannot provide: legal fees, fines, personal loans, retrieval costs for pawned items, insurance, regular expenses, items already paid for, call/data charges on your telephone or credit card debt. The checklist at the end of this form will assist you to complete the application correctly. It may be to your advantage to access a community /social worker, to assist with your application. All applications must be lodged by 4.00 pm Friday to 51 Commercial Rd South Yarra 3141 or marcus.smith@thorneharbour.org. All applicants are advised of the outcome by mail or, for pick up on the following Thursday. As a publicly funded organisation we are bound by the Victorian privacy laws - the Information Privacy Act 2000 and the Health Records Act 2001 - as well as other laws which impose specific obligations on us in regards to handling information. Files are shredded if not used for seven years.
Full Name*:
Address:
Postal add (if diff)
Date of Birth*:	Centrelink CRN:
Phone number:
Email address:
*Mandatory fields OR details via Penelope (THH INTERNAL)	
Item and payment information
Please note you may request multiple items but there is no guarantee that these will be granted. You must prioritise your requests as only one may be approved. The fund only provides payment to companies, not individuals.
Item:	Amount $:	Payable to:
1
2
3
eMail		Phone	
For pick up - call Positive Living Centre on 9863 0444 the following week to find out the outcome. If approved, food vouchers will be available after 1pm on the Thursday. If you are requesting one of the following, you do not need to attach quotes as the DWF has a supplier for these brand new products: Beds (queen mattress and base is assumed unless advised otherwise), electrical goods, direct from supplier deliveries. In all other cases, TWO quotes from different companies are required to accompany the application.
Other Funding Sources
Have other agencies been approached for assistance?	Yes		No	
Agency approached?
What was the outcome?
Are you requesting assistance with rent?	Yes		No	
If yes, which Housing Office did you apply to and what was the outcome?
Your Local Transitional Housing Office must be asked before putting in a DWF application. Please call 1800 825 955 to find your closest office.
Supporting Statement (required)
Please document below your current financial situation and degree of need, along with why you are in need of the item / service you are applying for assistance with.
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Changes since your last application
Have your income or expenses changed since your last application? If “yes” please document the changes below.
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Do you have financial concerns about any of the following?
Infringements / Fines		Gambling (self or others)	
Assets at Risk		Credit Debt	
Emergency Relief		Legal Action	
Overdue Utilities		Telco Debts	
Outstanding Bills		Rental Goods	
Afterpay		Payday Loans	
Other – Please specify:
Please give a brief description of your financial Issues:
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Client Consent Statement
I authorise the DWF to seek verification if and where necessary to confirm any information provided in this application or any applications I may make in the future. I certify that all the information provided is true and correct. I agree that the DWF may share and exchange information in order to assist in resolving my financial difficulties with other agencies / companies directly involved, for the purpose of providing me with the best possible support to suit my circumstances. I understand that relevant information about me will only be shared when deemed necessary or to progress my case or application and consent to my name, address and phone number being given to the DWF supplier
Client signature:	Date:
If prepared by case Worker on the Client’s behalf:
Case worker’s name:	Phone:
Signature:	Date:
Checklist:
	I have attached a copy of my current Health Care Card (or there is a copy on Penelope).
	This is my first DWF application in 2026. I have attached a copy of my current Centrelink Income Statement or have signed an authority for DWF to do get one for me. OR Please have a DWF worker call the client to arrange a verbal authority 
	I have attached quotes, if necessary, from two different suppliers.
	I have attached supporting documents such as support letters or outcomes from other organisations.
	For Rent applications – I have contacted my local transitional housing agent and have attached a copy of my lease agreement.
	I have attached a Tax Invoice or copy of my bill (to be considered, bills must be in your name), if appropriate.
	I understand that I may be asked to provide a supporting statement or evidence of financial hardship