Membership Application Membership Application Membership Application or Renewal Formn Name of organisation:*Application type*New MemberRenewing Member (most recent financial year)Renewing Member (previous financial year)Organisation Representative 1:* First Last Each Member Organisation is required under SCoA’s Constitution to nominate two representatives who become that Organisation’s delegates at official SCoA meetings. We suggest your organisation’s representatives are persons of suitable seniority within your organisation, with a high level of knowledge of the settlement sector and who are committed to contributing to SCoA from time to time where relevant. Job Title:*Email:*Direct phone:*Organisation Representative 2: First Last Job Title:Email: Direct phone:By naming the above representatives, I signify agreement to receive SCoA’s correspondence via email and circulate to relevant staff within the organisation.* Yes No Please list any other email addresses to whom you would like SCoA to send its newsletter and communications:It is possible to nominate unlimited additional delegates to receive SCoA communications. Details of CEO organisation (if not listed above):CEO's email: CEO's phone:Organisation's postal address:*Organisation's principal place of business (street address):Organisation's Phone:*Fax:Organisation's Email:* Organisation Website:*Organisation's ABN:*Key settlement services - Please tick accordingly any of the key settlement services covered by your organisation: Case Management Education and Information Events Advocacy Others Please briefly describe the settlement services or related services your organisation provides: Location of Services - Please tick accordingly the location of settlement services your organisation provides. Metropolitan Area Regional Area National Settlement Services Outcomes Standards (NSSOS) - Please tick accordingly those that apply to your organisation's settlement services towards SCoA's NSSOS: Education and Training Employment Health and well being Languages Services Transport Civic Participation Family Social Support Housing Justice Settlement Services and Support Services Funding - Please tick accordingly settlement services funding that applies to your organisation: Humanitarian Settlement Program Settlement Grants NSW Settlement Partnership Disability Employment Services PASTT AMEP SEE JobActive Providers Volunteer Grants Others Please provide a brief overview of any funding your organisation currently receives.(Please state the funding type, and if your service receives federal and/or state government funding)Please describe the way your organisation is governed and how members of the community(ies) you work with are involved in the decision-making of the organisation:Type of Membership*Full MembershipAssociate MembershipRenew Current MembershipOrganisation's Income*Income less than $50,000Income of $50,001 to $100,000Income of $100,001 to $500,000Income of $500,001 to $1millionIncome of $1 million to $5 millionIncome of $5 million to $10 millionIncome of $10 million plusMembership fees are determined by organisation's income. Membership fees can be viewed in Become a Member page.State/Territory of Registration:*ACTNSWNTQLDSATASVICWAI confirm that the organisation’s head office is in that State/ Territory.* Yes I confirm that the organisation meets SCoA eligibility for the member level indicated above (see SCoA website for more details).* Yes Member organisations are listed on the SCoA website. Do you agree to have your organisation listed on the SCoA website?* Yes No Attachments Drop files here or Applications for NEW membership are to include: • A letter expressing your interest in membership of SCoA written by a suitable delegate on behalf of the organisation); • A copy of the organisation’s Constitution and/or Rules.