Home → Live → My Family and I → Accessible Moonee Valley → Home and Community Care Program for Younger Persons (under 65)

What you need to know

Home and Community Care Program for Younger Persons (under 65)

Step 1 of 7

14%

Eligibility

Are you a resident of Moonee Valley?

Yes

Are you under 65 years old?(Required)

Yes

Do you require assistance to engage in enjoyable social activities due to chronic health condition(s), physical impairment or mental health concerns (ongoing or episodic)(Required)

Yes

Are you receiving NDIS?(Required)

Yes

Do you experience social isolation(Required)

Yes

Are you from a Culturally or Linguistically Diverse Background(Required)

Yes

Do you identify as part of the LGBTIQA+ community?

Yes

Are you at risk of Homelessness?(Required)

Yes

Do you care for a person who is eligible for HACC PYP services(Required)

Yes

You are not eligible to access HACC PYP social support groups at Moonee Valley City Council.

Program(Required)

Referral Source(Required)

Self

Carer/Family

MVCC Internal

External

Name(Required)

Organisation(Required)

Phone(Required)

Participant Eligibility(Required)

Yes

Please specify(Required)

Participant Details

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact number(Required)

Primary Disability

D.O.B(Required)

DD slash MM slash YYYY

Gender(Required)

Male

Female

Inter

Prefer not to say

Country of Birth(Required)

Australia

Other

Language(Required)

English

Other

Need For Interpreter(Required)

Yes

Are you Aboriginal or Torres Strait Islander descent?(Required)

Yes, Aboriginal

Yes, Torres Strait Islander

Income Source(Required)

Full Pension

Part Pension

Self-funded

Income type(Required)

Single

Couple

Family with Children

Income range(Required)

Low: Less than $36,438

Medium: $36,439 - $79,514

High: More than $79,515

Income range(Required)

Low: Less than $55,770

Medium: $55,770– $106,298

High: More than $106,298

Income range(Required)

Low: Less than $61,647 plus $5,877 for each child

Medium: $61,648 - $111,941 plus $5,877 for each child

High: More than $111942 plus $5,877 for each child

Living Arrangements(Required)

Alone

Couple

Single with Children

Couple with Children

With Others (Related)

With Others (Unrelated)

Accommodation(Required)

Owned

Private Rental

Public Rental

SRS

Marital Status(Required)

Single

Married

Divorced

Widowed

Partner

Child

Carer Details

Does the participant have a carer?(Required)

Yes

Does the carer reside with participant?(Required)

Yes

Name(Required)

First Last

DOB(Required)

Language(Required)

English

Other

Cares for others?(Required)

Yes

A/TSI?(Required)

Yes

Relationship to Participant(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Contact number(Required)

Emergency Contact Details

is the carer the same as the emergency contact to ?(Required)

Yes

Relationship to Participant(Required)

Emergency contact Name(Required)

First Last

Emergency Contact number(Required)

Health & Function

Health Conditions(Required)

Medication Requirements(Required)

Allergies(Required)

Yes

Specify allergies(Required)

Emergency Management Plan?(Required)

Example: Anaphylaxis, Diabetes, Asthma

Mobility(Required)

Independent

Unstable

Walking Stick

Walking Frame

Wheelchair

Other

If other, please specify(Required)

Falls Risk(Required)

Low

Medium

High

Transfer Assistance Required(Required)

Yes

If Yes, please describe(Required)

Level of Need(Required)

Low

Medium

High

Do you require assistance with the following

Housework

Shopping

Managing Money

Mobility (Independent or Aided)

Transport

Medication

Personal Care (Bathing, Eating, Dressing, Toileting etc.)

Using Technology (i.e. Computer or Smart phone applications such as Emailing, Zooming, Websites, MyGov, Social Media)

If Yes, please describe(Required)

Currently receiving any formal support services(Required)

Example: case management, Council, other organisation.

Yes

Who(Required)

Are you happy for us to contact them to discuss your situation with that provider/s?(Required)

Yes

Contact details(Required)

Do you have a companion card?(Required)

Yes

Do you have any communication requirements?(Required)

Example: hearing, speech, interpreter, etc

Yes

Do you have any memory or behavioural concerns?(Required)

Yes

Social Group Participation

What are your interests/What do you enjoy doing?(Required)

Why would you like to participate in the program?(Required)

Is there something that we do not offer that you would like us to consider?(Required)

What would you like to achieve during your participation in the social program?(Required)

What sort of assistance do you feel you will need when participating in group activities?(Required)

Example: mobility, bus transfers, dietary requirements, allergies, managing medication, communication, etc

Is there anything we need to know to make your participation as enjoyable as possible?(Required)

Example: dietary requirements, structure of program, reminders, information, familiarisation with environment.

Privacy and consent(Required)

Moonee Valley City Council (Council) is collecting your personal information in order to register you under our Support for Carers Program.

Council may use the information collected for the secondary purpose of notifying you of updates to our programs, events and Portal and to inform our reporting obligations to Federal and State Government agencies. Your personal information will be stored in Councils database/s. Council will not disclose your personal information without your consent, except where required or authorised to do so by law.

You also agree to indemnify and keep indemnified and to hold harmless the Moonee Valley City Council, its servants, agents and contractors from and against all actions, costs, claims, charges, expenses and damages whatsoever, which may be brought or made against them or any of them arising out of or in connection with the Moonee Valley City Council Program except to the extent that Moonee Valley City Council, its servants, agents and contractors are liable at law.

When attending programs/ events, you agree to work within your own physical and mental limitations at all times and inform of any change in your health circumstances which may affect your participation.

You agree when fee’s are applicable, you consent to the fee structure in place which will be informed in writing to you.

To request access to your personal information or for other queries regarding the privacy of your personal information, please email privacy@mvcc.vic.gov.au.

I agree to the privacy policy.

What you need to know

Home and Community Care Program for Younger Persons (under 65)

Eligibility

You are not eligible to access HACC PYP social support groups at Moonee Valley City Council.

Participant Details

Carer Details

Emergency Contact Details

Health & Function

Social Group Participation

Contact us

Opening hours

Acknowledgement

Climate emergency

Council sites

Language Line

Sign up for our newsletter

Social media

Language	Number
عربي	03 9932 1471
廣東話	03 9932 1472
Hrvatski	03 9932 1473
Ελληνικά	03 9932 1474
Italiano	03 9932 1475
Somali	03 9932 1476
Español	03 9932 1477
Türkçe	03 9932 1478
Tiếng Việt	03 9932 1479
All other languages	03 9932 1480

What you need to know

Home and Community Care Program for Younger Persons (under 65)

Eligibility

You are not eligible to access HACC PYP social support groups at Moonee Valley City Council.

Participant Details

Carer Details

Emergency Contact Details

Health & Function

Social Group Participation

Contact us

Opening hours

Acknowledgement

Climate emergency

Council sites

Language Line

Sign up for our newsletter

Social media

Subscribe to our VV online newsletter