FORM: 13
Supporting Children with Additional Needs
(SCAN) Program
Accountability Form
Supplementary Support for Preschools (Individual Child)
(to be completed by the Preschool)
Preschool Details
Preschool Name:
Contact Person:
Telephone:
Funding Period
 January – June
 July -
December
Children Details (attach additional pages as required)
First Name:
Last Name:
ACCESS CHILDREN SUPPORT. PO BOX 1168 BLACKTOWN 2148 ph: 02 9622 8500
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Expenditure
Total SCAN Program funds received (ex. GST)
$
Total expenditure for supporting funded children (ex.
GST)
$
Expenditure detail
Support Workers
Total SCAN Program funds
spent on support workers

No of Qualified
$

No of Unqualified
$
Certification
As the Nominated Supervisor of the preschool I certify that the attached information is true
and accurate
Nominated Supervisor’s Name:_____________________________________________________
Signature: __________________________________________ Date: ______________________
On behalf of the service I/we certify that the information provided on this form is correct.
(To be signed by two management committee representatives or the duly authorised delegate. If two are required to
sign then one must be the treasurer or person responsible for the management of funds)
Print Name: ___________________________
Print Name:__________________________
Signature: ___________________________
Signature: __________________________
Position:
___________________________
Position:
__________________________
Date:
___________________________
Date:
__________________________
ACCESS CHILDREN SUPPORT. PO BOX 1168 BLACKTOWN 2148 ph: 02 9622 8500
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