Mentorship Questionaire

Mentorship Questionaire

The answers you provide will assist us to get you the correct Mentorship package information.
Name*

First NameLast Name
Mobile Number*
Please enter a valid phone number.
Email*
example@example.com
Business Name
ABN/ACN
Area of expertise or focus?
Does your business need to be registered?*
What is your field?*

Support Worked (Independent, Registered through NDIS)Support worker (non-registered)Support Coordinator (Independent, Registered through NDIS)Support Coordinator (non-registered)Allied Health (Independent- Non-registered)Allied Health- (Registered through NDIS)Other (please specify below)
If you answered other above please specify here
What mentorship package are you interested in? (Please select all that apply)*

Full Mentorship Package, Core and Capacity Building Supports- (Registered through NDIS)Full Mentorship Package, Core and Capacity Building Supports Independent- non-registeredIT packageMarketing PackageAccounting Package
Registration Types

Please select all that are applicable
Class of Supports/Registration Group - NDIS Practice Standard Modules*

Accommodation/tenancy assistance - Verification Module (Verification)Assistance to access and maintain employment or higher education - Core Module (Certification)High intensity daily personal activities - Verification Module (Verification)Personal Activities Module - Verification Module (Verification)Assistance in coordinating or managing life stages, transitions and supports - Core Module (Certification)Assistance with daily personal activities - Core Module (Certification)Assistance with travel/transport arrangements - Vehicle modifications - Verification Module (Verification)Specialist positive behaviour support - Core Module Specialist behaviour support Module (Certification)Home modifications - Verification Module (Verification)Assistive equipment for recreation - Verification Module (Verification)Vision equipment - Verification Module (Verification)Community nursing care - Verification Module (Verification)Assistance with daily life tasks in a group or shared living arrangement - Core Module (Certification)Innovative community participation - Verification Module (Verification)Development of daily care and life skills - Core Module (Certification)Individual or Partnership (only) Early intervention supports for early childhood and any other verification registration - Core Module: Freedom from violence, abuse, neglect, exploitation or discrimination Outcome only Early childhood supports Module (Modified Certification)Early intervention supports for early childhood - Core Module Early childhood supports Module (Certification)Specialised hearing services - Verification Module (Verification)Household tasks - Verification Module (Verification)Interpreting and translation - Verification Module (Verification)Hearing equipment - Verification Module (Verification)Assistive products in household tasks - Verification Module (Verification)Communication and information equipment - Verification Module (Verification)Participation in community, social and civic activities - Core Module (Certification)Exercise physiology and personal training - Verification Module (Verification)Management of funding for supports in participant plans - Verification Module (Verification)Therapeutic supports - Verification Module (Verification)Specialised driver training - Verification Module (Verification)Assistance animals - Verification Module (Verification)Specialist disability accommodation only - Specialist Disability Accommodation Module (Certification)Specialist disability accommodation and one or more other registration classes/groups - Core Module Specialist Disability Accommodation Module (Certification)Specialised support coordination - Core Module Specialist Support Co-ordination Module (Certification)Specialised supported employment - Core Module (Certification)Hearing Services - Verification Module (Verification)Customised prosthetics - Verification Module (Verification)Group and centre-based activities - Core Module (Certification)
*Please note - Providers using restrictive practices in the delivery of any NDIS supports and services must also meet the: Implementing Behaviour Support Plans Module

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Mentorship Questionaire

Registration Types