Eligibility Form for SDA

1
What is your current NDIS status, Do you have any SDA/MTA/SIL approvals in your plan?* This field is required.
I am a current NDIS participant & have an NDIS registration number
I am an NDIS participant without a current plan
I have been approved for SDA ( Special Disability Accommodation ) and have it on my NDIS plan
I am awaiting SDA on my plan and can move into accommodation under my current core funding
I have MTA ( Medium Term Accommodation ) on my plan
I have SIL and looking for accommodation and have MTA on my plan
I am having issues with my current provider and need assistance with my NDIS plan
2
If you are NDIS registered, please enter your registration number* This field is required.If you have an NDIS number this will assist the NDIS registered providers to review your plan and understand that you acknowledged to disclose the information to ASDA Provider Group who may at some stage engage third party NDIS registered groups to achieve the best outcome for the participant and discuss the matter with the NDIS Commission if required.
By filling out the information above you acknowledge that you have given approval for ASDA PG to engage NDIS Commission
3
Which age bracket are you in?* This field is required.
18 – 29
30 – 49
50 – 64
65+
4
Do you require home automation technology?* This field is required.Google activation, voice activated products
YESNO
5
Do you require a bed hoist?* This field is required.If this is either a mobile hoist or a full ceiling support hoist
YESNO
6
Do you require the ability to call for support if required?* This field is required.
YESNO
7
Do you require 1:1 support for more than 5 hours per day and also need 24/7 back-up on call support?* This field is required.
YESNO
8
Are you currently living in a property that is not suitable for your needs?* This field is required.eg. you require High Physical support or other levels and also require assistive technology and other supports
YESNO
9
Where are you interested in obtaining accommodation?* This field is required.Please provider Suburb & State so we can achieve a better location outcome
eg. South East QLD
10
How did you hear about ASDA?* This field is required.
Friend/Family
Medical/allied health professional
Support coordinator
Google
Social media / Facbook / Instagram
ASDA PG Website
Other
11
Your name* This field is required.
First Name
Last Name
12
Your email* This field is required.
example@example.com
13
Phone number* This field is required.
Should be Empty: