Application for Membership to the Accord

Application form for membership to the accord
Part A - Organisation details
Organisation name*
ABN and/or registration details*
Phone Number*

Area CodePhone Number
Email*
example@example.com
Part B - Initiative details
Initiative name
Description
Please provide a brief description of your initiative.
This initiative addresses the following barriers to digital inclusion (please select all that apply):*

Connectivity (Support access to reliable, quality internet services that are fit for purpose)Affordability (Access to affordable digital devices, internet services and data)Skills (Western Australians to be able to use digital technologies and access the digital economy confidently)Design (Support making technology, websites, and apps more inclusively designed for everyone’s use)
This initiative supports the following digital inclusion cohorts (please select all that apply):*

People with disabilityPeople in regional and remote communitiesAboriginal communitiesOlder peoplePeople from CALD backgroundsPeople living on low incomes
Other partners or stakeholders
Please provide details of any other participants not part of your organisation.
Timeline
Please provide an approximate timeline for the initiative.
Authorisation

I hereby authorise our application to join the Digital Inclusion Accord and on our
commitment to working toward the collaborative achievement of the Accord outcomes.
Name

First NameLast Name
Job title
Signature

Clear
Date

DayMonthYear
Date
Enquiries regarding the Accord can be made via dgov-administrator@dpc.wa.gov.au or phone on (08) 6552 5000.
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Application form for membership to the accord

Part A - Organisation details

Part B - Initiative details

Authorisation