Unsolicited Requests

Unsolicited requests refer to proposals for collaboration with or funding from Western Victoria PHN (WVPHN) for primary health care initiatives and/or services that are outside a tender process.

WVPHN will consider submissions that align with our priorities and include but are not limited to requests for:

  • funding and/or resources for a primary health care service or training program to be delivered within the WVPHN region
  • sponsorship for a health-related initiative within the WVPHN region
  • in-kind work relating to a primary health care project or program within the WVPHN region.

Proposals can be submitted at any time. WVPHN will review and assess submissions annually between 1 October and 15 January.

For more details, ensure you read the Unsolicited Proposal Guide. Please note, this document will automatically download when you click the link.

Submit your unsolicited request

Please complete the required sections of this form and attach any relevant documents. It is important you note there are word limits per section.

Attachments will not be considered unless mentioned in the summary or relevant questions response.

An unsolicited proposal is an approach by a person or business, seeking funding from WVPHN for health services, projects or goods, outside of any formal approach to the market, on the initiative of the applicant.

This process will assist WVPHN to consider unsolicited proposals in a consistent and efficient manner.

You can select “send me a copy of my response” option at the bottom of this form.

  • Name of Project*

  • Email Address*

  • Applicant Form submission date*

    DD slash MM slash YYYY

  • Name of current Organisation (if applicable)

  • Name of Contact/Coordinator/Individual Applicant*

  • Contact Person's Position*

  • Applicant/s preferred contact phone number*

  • Postal address - Organisation/Individual Applicant*

    Include the full address (i.e. number & name of street, suburb, city, state and postcode). Please note that WVPHN will use this address for general correspondence

  • Applicant website (if available)

  • Executive Summary of Proposal*

    In the box directly below, enter the requested summary and ensure your entry does not exceed the word limit.

    Please proceed through and note you can attach any supporting documentation in the "file upload" box at the end of this form.

    Attachments will not be considered unless mentioned in the summary or relevant questions response.

    Word limit: 250 words

  • Applicant Capacity & Capability*

    Please give a brief history of the organisation, including demonstrated experience in delivering similar project.

    Word limit: 250 words

  • Project Aims & Objectives*

    Please briefly describe the aims and objectives of this project. Remember you can attach any supporting documentation in the "file upload" box at the end of this form.

    Attachments will not be considered unless mentioned in the summary or relevant questions response.

    Word limit: 250 words

  • Project Model / Activities*

    Provide an overview of the activities/services that will be conducted in the project, with approximate timeframes and key milestones. Indicate the geographic region/location of the project, and target population. What, when, where, who, who?

    Attach any supporting documentation in the "file upload" box at the end of this form.

    Attachments will not be considered unless mentioned in the summary or relevant questions response.

    Word limit: 500 words

  • Evidence for this approach*

    Please briefly summarise the evidence base for this approach/project. Attach any relevant supporting documentation in the file upload box at the end of this form.

    Attachments will not be considered unless mentioned in the summary or relevant questions response.

    Word limit: 250 words

  • Uniqueness of this approach*

    Does this proposal involve unique elements or innovate ideas? Please describe.

    Word limit: 250 words

  • Project Inputs and Resources*

    Briefly describe the staffing and resources that will be required for this project.

    Word limit: 250 words

  • Project Outputs*

    What will be generated in the process of delivering this project, e.g. services delivered, resources developed etc.

    Word limit: 250 words

  • Project Outcomes*

    What will change as a result of implementing this project? e.g. health status, risk factor, knowledge skills, behaviour, attitudes, access to services etc.

    Word limit: 250 words

  • Engagement, Partnerships & Evaluation*

    List relevant stakeholders to this project, and how they will be engaged, as well as any partnership arrangements.

    Word limit: 250 words

  • Project Evaluation Framework*

    Indicate the proposed method and indicators for evaluating this project.

    Word limit: 250 words

  • Financial Year*

    Provide budget and cost details for your project. Specify the financial year intended spends, cost estimates and overall project budget management plan.

    Word limit: 250 words

  • Project Attachments

    At this point in the form process, you are expected to review your application entry and ensure you are providing salient project details to substantiate your application within this form and should have been listed or mentioned in the summary or relevant question response.

    Any file attachments uploaded in the file upload box at the end of this form should support what you have entered in the form.

    The box directly below is optional but recommended you list any project attachments and how they support your application.

    Word limit: 250 words

  • Remember, only submit files that expand on the details you have provided in this form. Please do not provide documents that are not relevant to your application details nor support the rationale provided on this form. We appreciate you taking the time to review and check the accuracy of the application details and the relevant supporting documents you have provided on this form.
    Drop files here or
    Max. file size: 128 MB.
    Last modified: 15 December, 2020

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