This form is used to collect information that will assist the Department of Education and Training (the Department) to determine an approved p rovider’s eligibility to receive kindergarten funding and enter into a Service Agreement with the
Department. Please note that the form should be completed following discussions with your appropriate regional office that will then provide you with a Service Agreement pack should you qualify to enter into a Service Agreement with the
Department.
The Department has a range of funding mechanisms to promote participation in high-quality kindergarten programs delivered by a qualified early childhood teacher for children in the year before school. Service providers can apply to receive a grant for each eligible child who is enrolled and attending a funded kindergarten program for a minimum of 15 hours per week (or 600 hours per year).
It is expected that you are familiar with the kindergarten funding requirements contained in the Kindergarten Guide prior to submitting this form. The Kindergarten Guide can be viewed on the Department’s website: www.education.vic.gov.au
Please provide the following information if you are interested in entering into a Service Agreement with the Department for the purpose of kindergarten funding.
Service provider name:
Service provider address:
Title: Given name:
Position:
Telephone no. (business hours) :
Family name:
Email address:
Mobile no:
Does the service provider have an Australian Business Number (ABN)?
Yes
No
If Yes, please provide the ABN:
Applicable from Jan 2013

Copy pages 2 and 3 for additional services
Service Name:
Service Address (must be located in the state of Victoria) :
Is the service an approved education and care service operated by an approved provider as defined by the Education and
Care Services National Law Act 2010 and Education and Care Services National Regulations 2011?
Yes
No
If Yes, please provide:
The Approved Provider number:
If No, please provide the status of the application:
The Service Approval Number:
Does/will the service offer a kindergarten program delivered by an early childhood teacher who holds a qualification that is included on the list of approved early childhood teaching qualificatio ns published by the Australian Children’s Education and
Care Quality Authority (ACECQA)?
The ACECQA list of approved qualifications for work as an early childhood teacher in a funded kindergarten program can be found at: http://acecqa.gov.au/Early-childhood-teaching-qualifications
Yes
Please attach a copy of the teacher’s approved qualification
No P lease attach a copy of the teacher’s qualification (and letter of equivalency from ACECQA if applicable)
If No, please explain why:
Please attach evidence that the service provider has a business plan and budgets showing ongoing financial viability.
For example, a business plan, audited financial reports for at least the previous two years and/or two year budget forecast.
Please describe below how the new service will;
 meet a community need and/or
 be reflected in municipal early years plans and
 impact on existing services in the area
Does/will the service offer a kindergarten program of 15 hours per week for 40 weeks per year, or a minimum of 600 hours per year, delivered by a qualified early childhood teacher?
Yes
No
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How many children are or will be accessing a kindergarten program at this service? number of children
Children must be; at least 4 years old on 30 April of the year in which they are enrolled to attend the funded kindergarten program (unless they have been approved for early entry); enrolled for at least 15 hours per week or 600 hours per year; and, not enrolled and attending a funded kindergarten program at another service.
The person named below warrants that he/she is duly authorised to certify information on behalf of the organisation and that he/she certifies that the information provided herein is complete and correct.
Name:
Position:
Please ensure the following actions have been completed before submitting this form
A copy of the teacher’s qualification (and letter of equivalency if applicable) is attached
Financial documents are attached to show ongoing financial viability
Date:
The Department is committed to protecting the privacy, confidentiality and security of personal information. The
Department, and all service providers funded by the Department, are required to comply with the Information Privacy Act
2000 and the Health Records Act 2001.
All personal information collected on this form will only be retained in order to progress the expression of interest for kindergarten funding from the Department. Once the process has been completed, this form will be stored on record as supporting documentation for the application process.
You have a right to request access to, and to request correction of, the personal data in relation to your request. Prior to account creation, requests to update information should be directed to your Department contact. Following account creation these personal details can be updated by users directly through the eduPass application.
This Expression of Interest should be returned to the relevant Department regional office. Regional addresses can be found at: http://www.education.vic.gov.au/about/contact/regions.htm
On receipt of the Expression of Interest, the Department regional office will assess your organisation’s eligibility to enter into a service agreement with the Department prior to forwarding you a Service Agreement Pack.
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