ILC 1:1 capacity building referral form

  • ILC 1:1 Participant Referral Form

    Hastings Neighbourhood Services: Information, Linkages & Capacity Building Program (ILC)

  • Please note that the ILC program is not funded to facilitate NDIS or DSP applications. You can get support for NDIS applications from Blue Sky Local Area Coordination Team. You can get help with DSP applications from Centrelink social workers, your GP and or your employment support provider.

    In addition, our ILC program does not provide in-home support services.

    Our service is funded to assist clients build their capacity to engage in their community with confidence. We assist with barrier assessment, goal planning and strategy activation supports that lead to independent community engagement. We will assist participants with skill development, social interaction practice, paperwork, inclusion support challenges like application forms, transport set up, and peer support. (If you are a service referring on behalf of a participant, please answer to the best of your knowledge.)

  • Format: (000) 000-0000.
  • DOB:*
     - -

  • Personal Information

    Please select Yes or No (if you a service referring a client, please answer to the best of your knowledge)
  • Do you identify as living with a disability?*
  • Do you identify as living with mental illness?*
  • Do you have any barriers that impact your ability to undertake daily tasks, engage in social environments or participate in your local community?
  • Are you currently receiving any formal or informal supports?
  • Would you be interested in attending information sessions and/or group programs?*
  • Would you be willing to work 1:1 with a peer support worker to develop goal plans and receive support?*

  • What support are you wanting to receive / what barrier are you wanting to address?

  • Which of our 5 locations would you like to access services from?
  • Do you agree to be contacted by an ILC team member?*
  • Do you identify as Aboriginal or Torres Strait Islander?*
  • Was this form completed by someone other than the participant?*
  • Do you have permission to sign on behalf of the participant?*
  • Date*
     - -
  • Should be Empty: