Community Phone Nomination and Agreement Form (HTML)

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Under the Indigenous Communications Program, remote Indigenous communities with fewer than 50 people that also lack reasonable access to a public payphone may qualify for a community phone—either a fixed telephone or a mobile satellite handset.

Anyone with an interest can nominate a community for a community phone. To nominate a community phone, please complete the online form on this page to submit an application directly to the Department. Or else download the PDF form, complete it and return it by post, email or fax:

PDF fileCommunity Phone Agreement and Nomination Form (PDF, 289 KB)

What is on offer

The department offers the community:

  • Supply and installation of a free phone (fixed community phone or mobile phone) for community use
  • Free delivery
  • Supply of pre-paid calling cards (satellite mobile phone only)
  • Responsibility for maintaining and repairing the fixed community phone, but you will help if we ask you
  • Two-year extended warranty on the satellite mobile phone

Communities' responsibilities:

  • Take care of the phone
  • Ensure the phone can be used by everyone in the community
  • Advise the department on 1800 355 014 if the fixed community phone and/or the satellite handset is not working (do not ring Telstra direct)
  • Help all community members understand how to use the fixed community phone or satellite handset
  • Give the department any information you can provide if we ask about the phone or handset

* Indicates mandatory fields

Indicate the community's preference for a fixed phone or satellite handset

Fixed phone—the community receives:

  • A fixed community phone that operates with pre-paid cards and offers some free calls
  • Instructions on how to use the phone
  • Help to keep the phone working
  • Free emergency calls
  • Free incoming calls
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Satellite handset—the community receives:

  • A satellite handset complete with everything required to work properly
  • Three years' rental paid by the department for the satellite handset line
  • Up to three lots of pre-paid cards
  • Free emergency calls
  • Free incoming calls
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About the community

*Community name:

*State/territory:

Alternative community name:

GPS coordinates:

*How many people are usually in the community, including children (to be eligible, your community population must be under 50)?

*Is the community occupied for more than six months of the year?

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*Are there permanent dwellings in the community?

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If Yes, how many are there?

*Is there reliable mobile coverage in your community?

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If Yes, how many people have mobile phones?

How many people in the community have a home phone?

**Any particular issues / circumstances within the community that we should know about, e.g.—for example health or safety issues, difficulty getting to the existing (closest) phone? Please provide detailed information.

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*If Yes, please include what they are:

*Is there a public access phone in the community?

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If not, distance to nearest public access phone, Distance/Town:

Indicate the community’s preferred locations for a fixed phone. (Provide two sites. Take into account 24-hour accessibility and lighting). Please attach a sketch or location map showing where the phone would be installed.

If the community's preference is for a satellite handset please provide the name of the responsible corporate organisation and contact details for a person within the organisation. The satellite handset will be registered to the organisation.

Nominating officer

Your details if you are nominating the community for a phone or the details of the person who identified the community as needing a phone.

*Name:

*Phone:

*Email:

*Position:

Community representative

Nominating officer's declaration

*I confirm that I understand the community’s responsibilities for the phone and I have consulted with the community.

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*Name of community representative:

Organisation (if appropriate):

*Address

*Phone:

*Email:

Endorsing Australian, state/territory or local government official

Nominating officer's declaration

*I confirm that I have consulted with an official from the Australian, state/territory or local government about the community’s need for a phone and they can certify the information contained in this form is correct.

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*Name of endorsing officer:

*Position/designation:

*Agency:

*Business address:

*Phone:

 
 
 
 
Document ID: 126316 | Last modified: 9 December 2011, 3:16pm