NDIS Funding Application Form

NDIS Funding Application Form

Apply for NDIS support by completing this easy-to-follow application form. Please answer all questions and upload any supporting documents.
Applicant Details

Tell us about the person applying for NDIS funding.
Full Name

First NameLast Name
Date of Birth (You must be under 65 on the day you apply)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you applying for yourself or on behalf of someone else?
If applying on behalf of someone else, please provide your name and relationship to the applicant
Current Residential Address (You must live in Australia)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Do you usually live in Australia and spend most of your time here?
What is your citizenship or visa status?
If you selected "Other / Not sure", please provide details
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Do you need an interpreter or communication support?
If yes, please tell us what language or support you need
Do you identify as Aboriginal and/or Torres Strait Islander?
Disability and Support Needs

Help us understand your situation and support needs.
Do you have one or more impairments that are, or are likely to be, permanent?
Describe your main impairment(s) or condition(s)
How long have you had this impairment or condition?
Has a health or allied health professional told you the impairment is likely to be permanent?
How does your impairment affect your daily life? (moving around, communicating, socialising, learning, self-care, self-management)
Does your impairment affect your ability to work, study or take part in social activities? If yes, please describe how.
Do you think you will need disability supports for the rest of your life?
Are you seeking support mainly under the disability requirements, early intervention, or both?
If you are seeking early intervention, how do you think early supports will help you now and in the future?
Is the person a child under 6 with developmental delay?
If yes, please describe the developmental delay and how it affects the child’s daily activities.
Do you currently receive any supports (for example, from health services, community services, school, or other government programs)?
What NDIS-type supports do you think you need? (for example, therapies, equipment, help with daily activities, support to participate in the community)
Is there anything else about your situation you would like us to know?
Consent to share and obtain information from other services (for example, Centrelink, health professionals) to help assess your eligibility
Upload any supporting documents or reports from health or allied health professionals

Cancelof
Signature of applicant or authorised representative
Name of person signing
Date signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

NDIS Funding Application Form

Applicant Details

Disability and Support Needs