Application for Fully Funded Access to

with Emotional and Practical Support for Parents Going Through Separation

We are offering 2 x fully funded spots in our Rise & Rebuild Program (valued over $8k) for parents who are ready to do the work and have the best outcomes for their children.

These spaces are reserved for deserved parents experiencing financial hardship and unable to afford the program benefits without support .

This form takes approx 5 minutes to complete, please just complete it as honestly and openly as you can.

We will review all applications after the cut off date 05/01/2026 and successful applicants will be notified by 09/01/2026.

Click below to find out what is included:

https://superchargedu.com.au/rise-and-rebuild

PERSONAL DETAILS

Email *

We will use this to send updates about your application

First Name *

Last Name *

Phone *

Are you applying One Parent or Both Parents *

If applying as both parents (co-parent), program access will be shared. Sessions can be attended together, or split individually. If taken separately, each parent will receive half the total sessions.

Second Parents First Name (if applicable)

Second Parents Last Name (if applicable)

Second Parents Email (if applicable)

Second Parents Mobile (if applicable)

Do both Parents agree to participate fully and respectfully, keeping the focus on the children's wellbeing?

Yes

YOUR SEPARATION AND CURRENT LIVING ARRANGEMENTS

How long have you been separated for? *

What are your current living arrangements? Living alone, still sharing a home, renting, home owner *

What is your current shared care agreement? *

YOUR CHILDREN

Tell us about your children (personalities, what they are going through right now) *

How do you think your children will benefit from you completing this program? *

YOUR COMMITMENT & VALUES

What support do you need most from Rise & Rebuild (e.g emotional, mindset, practical) and why? *

What is the biggest outcomes you want from the program? *

Our Community is built on respect, accountability and compassion, which of these values resonates most with you and why? *

At the end of the program will you be willing to provide feedback to help us improve and inspire others? *

Yes

FINANCIAL ELIGIBILITY

Do you consider yourself in genuine financial hardship that prevents you from accessing this program without support? *

Yes

Please share a little about your current financial circumstances (e.g. job loss, reduced income, government support). *

Upload one simple proof of circumstance *

Centrelink Statement

Health Care / Concession Card

Pay slip or income bracket evidence

Or leave blank if not comfortable, we will still consider your application

Please redact any identification or personal details

If I my application is successful, I understand and confirm the following:

The program must start within 30 days. Our terms and conditions apply and the placement is not transferable

I agree to attend sessions, complete activities and uphold respectful communication, if I do not participate meaningfully, my place may be reallocated