EOI Form

Thank you for your interest in submitting an Expression of Interest (EOI) for the implementation of an innovative model of care to improve equity of access to primary health services.

This is a two-stage EOI process. This survey relates to Stage One, which is designed to gather initial proposals. Please note that no funding is associated with this stage. Shortlisted applicants will be invited to participate in Stage Two, where further assessment and consideration for funding will take place.

Please complete all questions to the best of your ability. If you have any questions, feel free to contact the Rural Health Access Team for support.

Applicant contact name

* required

Maximum 255 characters

0/255

Applicant contact primary phone number

* required

Maximum 255 characters

0/255

Applicant contact primary email

* required

Business or organisation name

* required

Maximum 255 characters

0/255

Proposed location for your initiative

* required

Select option

Start typing your town in the bar to search for location.

Describe your connection to the community where the initiative will be implemented.

* required

What is the intended population for this model of care?

* required

What are the key health needs and access barriers faced by this population?

* required

What services are currently in place?

* required

10.

Describe your model and how it improves or differs from the current approach.

* required

11.

Requested amount of STEM funding (maximum $50,000)

* required

12.

How will this initiative improve equity of access to primary care?

* required

13.

How will the funding support project delivery and impact?

* required

Note: STEM funds cannot be used for salaries, wages, travel, accommodation, or capital works.

14.

How will the initiative be funded and sustained post-pilot?

* required

15.

What measures will you use to assess increased equity of access?

* required

16.

Is there any additional support would you like from the PHN?

* required

Yes

17.

Additional comments

Is there anything else you would like to add?

18.

Have you consulted with any stakeholders (e.g. healthcare providers, local council)?

* required

Yes

Not sure

19.

Are you open to partnering with others (e.g. community groups, NGO, council, LHD, healthcare providers)?

* required

Yes

Maybe

20.

Can this project be delivered within the 2025–26 financial year?

* required

Yes

Maybe