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...helping the Mid North Coast through crises!

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Vouchers

Student Technology Vouchers (eGift cards)

...are being allocated to support the purchase of technology required for school such as...

| Calculators | Laptops | Headphones |

You can choose only one retailer listed above.

All vouchers (eGift cards) can be redeemed on-line or in-store.

Thank You

Vouchers (eGift cards) can be redeemed at:

Harvey Norman
Officeworks

for your support!

1. Complete all fields
& questions in the form.
2. You MUST read the Media Release Consent Form and answer YES if you want photos to be used.
3. You MUST press the
SUBMIT button at the bottom so we receive your application.
We will get back to you via Email once your application has
been assessed.

Applying
is
easy!

Student Technology
Voucher Application

Applicant's Name

Country Code

Phone

Street Address

Property Name or PO Box

Suburb

State

Post Code

Student's Name

A new application needs to be completed for each student.

Able to provide?

Are you Working? (Must supply 3 Pay Slips)

Ability to participate in a quick survey regarding how the voucher(s) have made an impact on the student(s) education?

Yes

Optional: Willing to provide a photo of student(s) with item(s) you have purchased? If YES, you need to Read the Media Release Consent Form (see below) and acknowledge it has been read.

Yes

Click Here to View the Media Release Consent Form

I have read the Media Release Consent Form.

Yes

Interested in receiving surveys from Mid Coast Outreach in future? (Optional)

Yes

Preference for Voucher Type? (depends on Availabilty)

Harvey Norman

Officeworks

Student's School(s) (NA if not in school)

Home Schooled

Yes

Current Year that student is enrolled in?

Thanks! We will be in touch by email once your application has been assessed.

Good Luck!

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