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Registration Form

Fill out the form carefully for registration
Please select which program suits your needs:
Participant details
Participant's name*

First nameLast name
Post code*
Participant email
example@example.com
Participant mobile number
Format: (000) 000-0000.
NDIS number
NDIS plan expiry date

DayMonthYear
Date
Support Coordination details
Support Coordinator's name*
If no support coordinator, then the nominee's name if under 18
Support Coordinator's mobile number*
Format: (000) 000-0000.
Support Coordinator's email*
NDIS Goals
Upload NDIS Plan

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NDIS Orientation Pack
As part of the NDIS provider responsibilities Changing Gears is required to provide participants with adequate information to allow participants to access, engage with and navigate our service. Information regarding the following topics can be found in our NDIS Orientation Pack;

- NDIS speciﬁc registration form
- Consent to share information
- Information storage
- Service agreements
- Complaint policy
- Program delivery guidelines

Further information can be found on our website changinggears.org/ndis
I have accessed and viewed the Changing Gears NDIS Orientation Pack
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Registration Form