ABCF Canberra Brain Cancer
 Patient and Family Care Initiative

Program Registration Form

Please complete this form to register for ABCF Brain Cancer Support Programs including:
  • The Canberra Brain Cancer Support Team (BCST) (delivered by Peace of Mind Foundation (POMF)), 
  • The ABCF Financial Hardship Grants (FHG) program, 
  • The Canberra Brain Cancer Family Network Group (FNG) program (in partnership with Brain Tumour Alliance Australia (BTAA)), 
  • The ABCF GIVIT program, 
  • Aurabox and, 
  • The Brain Cancer Patient and Community Feedback Questionnaire.

**This form must be completed by either the patient, or with the consent of the patient, a medical practitioner, a family member or a carer.**
 
This registration of interest form allows families and individuals to express their interest in all of our programs and stay informed about their development and deployment.
 
CURRENT PROGRAMS
1. Brain Cancer Support Team Program
The Canberra Brain Cancer Support Team (BCST) program, delivered in partnership with the Peace of Mind Foundation (POMF), provides in-home and community-based support to brain cancer patients and their families.

Support Services Include:

  • Emotional and practical support from a dedicated brain cancer navigator
  • Assistance with daily household tasks and practical in-home support
  • Access to bereavement and grief counselling
  • Access to financial assistance
  • Access to POMF national Advocacy Service
This program ensures that brain cancer patients and their families receive comprehensive, compassionate support tailored to their unique challenges. By providing both emotional and practical assistance, the BCST program aims to ease the burden on families and improve their quality of life. Find out more about the program here.
2. Financial Hardship Grant (FHG) Program
The FHG program offers brain cancer patients, care givers and their immediate family, financial assistance with: 

  • Accommodation and travel expenses for treatment 
  • Childcare during medical procedures or treatments 
  • Access to rehabilitation services 
  • Counselling for patients, carers, and family members 
  • Tutoring and after-school support for children 
  • Essential household expenses (e.g., groceries, utility bills) 
  • End-of-life wishes and memory-making experiences 
  • A one-off payment of $10,000 for Celebration of Life costs 
We appreciate your patience and understanding as we work to secure the necessary funding to bring this program to life. Find out more about the program here.
3. ABCF GIVIT Program
The ABCF GIVIT program is designed to provide essential items and services to brain cancer patients and their families by connecting them with donors across Australia. Through our partnership with GIVIT, we ensure that families facing financial hardship receive much-needed support, including:

  • Grocery and fuel vouchers
  • Home essentials and furniture
  • Assistive technology and medical equipment
  • Support services such as meal delivery and cleaning
This program is aimed at reducing financial stress and ensuring families have access to critical resources during their brain cancer journey. We encourage eligible families to register their needs so that we can match them with available donations. Find out more about the program here.
4. Canberra Brain Cancer Family Network Group Program
The Canberra Brain Cancer Family Network Group (FNG) is a collaboration between ABCF and Brain Tumour Alliance Australia (BTAA) that provides monthly support sessions for brain cancer patients, carers, and families.
The BTAA  is the leading national brain tumour patient and caregiver advocacy organisation, providing crucial support services, resources, and advocacy for individuals affected by brain cancer.

Program Details:
Launch Date: July 2025
Location: Griffith Centre, Canberra
Frequency: Monthly (Second Sunday of Each Month)
Attendees: Brain cancer patients, caregivers, and family members

This program fosters a supportive environment where families can share experiences, access professional guidance, and build a strong community of support. Find out more about the program here.
5. Partnership with Aurabox
A collaboration between Aurabox and the Australian Brain Cancer Foundation (ABCF) presents an exciting opportunity to enhance patient care through cutting-edge medical imaging technology. Aurabox’s innovative platform streamlines the sharing and analysis of medical images, allowing clinicians to collaborate seamlessly for faster, more accurate diagnoses.
6. Brain Cancer Patient and Community Feedback Questionnaire
The ABCF is dedicated to developing new programs to support the community, patients, and their families.  We want to hear feedback and suggestions directly from the community to ensure our programs continue to meet your needs and how we can continue to support you. 

Please complete the Patient and Community Feedback Questionnaire at the end of this form to help us better support you. 
Guidelines and Registration
Our program registration is divided into: 
  • PART A: General Guidelines for Registrations 
  • PART B: Registration Form
  • PART C: Communications Agreement
  • PART D: Patient and Community Feedback Questionnaire (optional)
Please read these guidelines carefully before completing your registration.
PART A: General Guidelines for Registration
Introduction 
All of the programs below have been initiated and developed by the Australian Brain Cancer Foundation. Our programs aim to provide direct assistance to families, carers and patients affected by brain cancer in the Canberra region, aiming to provide practical support, mental health support and alleviate financial stress. 

Eligibility Criteria for all programs (except the Financial Hardship Grants program)

Families must meet all the following eligibility requirements to apply: 
  • The applicant (a brain cancer patient of any age) is diagnosed with brain cancer or is a caregiver or family member to a patient (of any age) with a brain cancer diagnosis. 
  • The patient, family or carer resides in the ACT region. 

Additional Eligibility Criteria for the Financial Hardship Grants program
  • In addition to the above, the following must be provided:
  • A support letter provided by a qualified Social Worker, practicing Oncologist, or General Practitioner that includes: 
    • Full name of the patient 
    • Diagnosis details, including date and type of brain cancer 
    • Treating hospital or medical institution 
    • Estimated length of treatment 
    • A brief description of the family’s circumstances 
  • For End-of-Life Wishes, families who have recently lost a loved one to brain cancer (within the past month) must also provide either: 
    • A Certificate of Death; or 
    • A support letter from a Social Worker verifying the circumstances.
  • For GIVIT applications, a list of items or supports requested.

Registration Process 
Registrations will be reviewed based on the following steps: 
  1.  Registration will be reviewed in the order they are received. 
  2. If funding/service are immediately available, eligible registrations will be approved for the full amount or services requested. 
  3. If funds are limited, partial access to services or grants may be provided to ensure support is extended to as many families as possible. 
  4. Families whose registrations cannot be approved due to insufficient funds will be placed on a waiting list for up to six months and contacted when funds/services become available. 
Once funding is secured families will be notified via email within 7 days of submitting their registrations and advised of the outcome as soon as possible. 
  
Supporting Evidence Requirements for Financial Hardship Grants only
Applicants must include the following documents: 
  • Proof of residency in the Canberra region (e.g., photo ID or utility bill). 
  • A support letter from a qualified Social Worker, practicing Oncologist, or General Practitioner. 
  • For End-of-Life Wishes, a Certificate of Death or equivalent documentation must be provided. 
  • For FHG applications, bank account details for grant disbursement (Account Name, BSB Number, Account Number, and Bank Name). 
PART B: Registration Details Form 
Checklist for Submission 
To ensure your application is processed without delay, please confirm that you: 
  • Meet the eligibility criteria as outlined in the guidelines. 
  • Have attached proof of residency (e.g., photo ID or utility bill) 
  • Have included a support letter from a Social Worker, practicing Oncologist, or General Practitioner. 
  • Have provided bank account details for grant disbursement. 
  • For End-of-Life Grants, have included a Certificate of Death or support letter verifying the circumstances. 
  • Have completed all sections of the application form.
Once submitted, the ABCF will communicate directly with applicants via email. 
Patient information
Please complete the patient's details below
Date of birth
Gender
Brain Tumour Diagnosis
(name, type, location, or any other details you feel comfortable sharing)
Diagnosis date
Treating Hospital
Treating Oncology Doctor
What is the total distance you travel for treatment? 
Carer's information (if applicable)
Carer's Name
Carer's contact number
Carer's email address
Referrer's information (if applicable)
Referrer's name
Referrer's Organisation
Referrer's Position
Referrer's contact number
Referrer's email address
Support Service Request
Type of Service (required)
Please select all the services you would like to apply for or would like to hear more about.







If you were to receive financial assistance, which of the following areas would you prioritise? (optional)










Please add any additional comments or queries here: (optional)
Financial Grant Application (the following questions are mandatory if you are applying for a grant)
Please indicate which grants you would like to be considered for by selecting from the options below. 
You may apply for multiple grants. If selecting more than one, please prioritise your family’s needs by ranking them from 1 (highest priority) to 6 (lowest priority). We will do our best to assist in all the areas you have identified. If we are unable to fulfil all requests, we will prioritise your top-ranked need.

Available Grant Options:
Accommodation and Travel escape for treatment Grant
Support for costs related to accommodation and travel for medical treatments outside Canberra. 
Childcare/Babysitting during medical procedure or treatment 
Assistance with childcare or babysitting costs during treatment or medical appointments. 
Rehabilitation and Counselling  
Access to rehabilitation services and counselling sessions for patients, carers, and family members. 
Household Expenses Grant 
Financial support for essential household costs such as groceries and utility bills. 

Education Transition Support 
Tutoring and educational support for children up to Year 12 to help them stay on track academically. 

One-Off Celebration of Life Grant (for families who have lost a loved one to brain cancer) 
Assistance with farewell arrangements, memory-making activities, or keepsakes. 

Additional Information: 
Please provide a detailed summary of the patient's diagnosis and current prognosis (if available), along with information about their treatment plan. This information will help us better understand your family’s specific needs and how we can assist. 
Please include the following information for your application to be considered: 
Proof of Address 
Please upload proof of address, such as a photo ID or utility bill. 
Referral Letter 
Please include a referral letter from your Social Worker or practicing Oncology Doctor. 
For Celebration of Life Grant 
Please include a Certificate of Death or a support letter confirming the passing of your child. 
How did you hear about the FHG Program?
Declaration 
By submitting this application, I declare that all the information provided herein is accurate and true. 

I understand that by submitting this application, I agree to the receipt of applicable grants if my application is successful and agree to be contacted by the Australian Brain Cancer Foundation using the contact details provided. 
Full Name of Patient or Guardian/Carer:
Date
PART C: Communications Agreement 
In order to provide you with some services, including the Canberra Brain Cancer Support Team, ABCF GIVIT and the Aurabox program, we require your consent to share your contact information with them to provide you with services. 
We promise they will not spam you with requests.

We also invite you to share your family's story to help provide the broader community with insights into how they can support families affected by brain cancer. 

Please indicate your level of consent below.
Consent for sharing of information solely for the provision of services
I give my consent for the Australian Brain Cancer Foundation to share my contact details with Peace of Mind Foundation, Brain Tumour Alliance Australia and/or Aurabox and/or GIVIT for the provision of services.
Consent for Sharing Information
I give my consent for the information provided herein to be shared by the Australian Brain Cancer Foundation through the following platforms (Please note: No private information, such as contact details, address, email, or bank account information, will be shared.) (please select all that apply)




Consent for Sharing Photographs 
I give my consent for any photographs I provide to be shared in accordance with the consents selected above. 


Permission for Personal Contact 
I give permission for the Australian Brain Cancer Foundation to contact me via phone or email to discuss my application or to refer me to other services beneficial to our journey with brain cancer. 


Full Name
Date
Part D is an optional questionnaire that we use to further develop our programs. We would appreciate it if you were to complete it, however if you simply want to submit your application without completing this section, please scroll down to the green "Submit Application" button below. 
PART D: Patient, Carer and Community Feedback Questionnaire (optional)
The ABCF is dedicated to developing new programs to support the community, patients, and their families. Our first two initiatives, the Brain Cancer Support Team and the Financial Hardship Grants, have been thoughtfully developed in consultation with the community to address critical needs and provide meaningful assistance. We want to hear feedback and suggestions directly from the community to ensure our programs continue to meet your needs and how we can continue to support you. 
Notes:
  • All information gathered will be kept confidential. 
  • We will not share your identifying data with any other company, agency or individual.
  • You do not need to complete all questions, and we would really appreciate your input.

You can opt in to receive the results of the survey and further communication from us relating to this project upon completion.
Demographics
Please select your role:



Age:





Gender:



How many people are in your immediate family? (select all that apply)







Household Annual Combined Income:






How long have you or your loved one been dealing with brain cancer?




If you feel comfortable, please specify the type and stage of brain cancer:
Medical Care and Treatment
How satisfied are you with the medical care and treatment options available for Brain Cancer patients in Canberra?





How satisfied are you with the medical care and treatment options available for Brain Cancer patients at the Canberra Hospital?





Would you like to provide additional details?
Have you encountered any challenges or difficulties related to accessing medical care and treatment for brain cancer in Canberra? (optional)
Please describe your experiences:
Please share any positive experiences you have had while accessing medical care and treatment for brain cancer in Canberra? (optional)
Financial and Support Needs
Are there any other specific financial or support needs not mentioned above that you believe are important for brain cancer patients and caregivers in Canberra? Please describe:
If you would like to, please share your story with us below. 

Please indicate if you would like us to contact you to share your story or if you would like to opt in to see the results when they are ready.



Are there are any other programs or services that you think the Canberra community would benefit from or that you would like to see?

The Australian Brain Cancer Foundation Ltd