Beyond Embrace Expression of Interest Form

Beyond Embrace – Expression of Interest (EOI) Form

This form helps us understand you, your goals and the support you need so we can create the right starting point in the Beyond Embrace pathway.
Participant Details
Full Name*

First NameLast Name
Preferred Name (if different)
Date of Birth*

DayMonthYear
Phone Number*
Email Address*
example@example.com
Is this form being completed by a parent, carer, plan manager or support coordinator?*

NoYes
Contact Person (if applicable)
Name (Contact person)

First NameLast Name
Relationship to Participant (Contact person)
Phone Number (Contact person)
Email Address (Contact person)
example@example.com
About You
We want to get to know you as a person, not just your work goals. This section helps us understand your interests, strengths and what matters to you outside of work.
Tell us a little about yourself (e.g. interests, hobbies, what you enjoy doing?)*
Have you worked or volunteered before?*

YesNo
If yes, what kind of work have you done?
Your Employment Goals
This section helps us understand what you would like to work towards. You might already have a goal, or you might still be figuring it out, both are okay.
What would you like to get out of this program?*

Build confidenceTry working in a real environmentLearn new skillsMeet new peopleWork towards getting a jobOther
Embrace offers a range of roles across our business. This helps us understand what you are curious about and where you might like to start learning. Which areas of the business are you interested in exploring? (Choose as many as you like) *

Cafés (customer service, making drinks, front of house)Kitchen (food preparation, cooking, food safety)Catering (preparing and delivering food for events)Events (set up, service, working at functions)Administration (organisation, systems, behind-the-scenes support)Marketing (social media, content, promotion)Delivery (transporting food or supplies)Not sure yet, I’d like to try a few different areas
Do you have any current NDIS goals related to work or independence? (optional)
Support Needs NDIS Funding
Everyone learns and works differently. This section helps us understand what support works best for you and whether you currently have NDIS funding for a Job Coach during the Learn Program.

The Learn Program includes 1:1 Job Coach support during each shift.
This support is funded through your NDIS plan under:
Assistance with Social, Economic and Community Participation.
Do you currently have funding in your NDIS plan that can be used for 1:1 support during work or community participation?*

YesNoNot sure
If yes, please provide any details you know
To participate in the Learn Program, participants need access to NDIS funding for a 1:1 Job Coach support during the 8-week program.

I understand that I need this funding to take part in the program
If you do not currently have this funding, that is okay. We can still support you by:
- Providing information for your next NDIS plan review
- Helping you understand what to request
- Staying in touch for future program opportunities
I would like support preparing for my next plan review

Yes
What month is your annual plan review?*
How do you like to be supported when learning something new? (e.g. step-by-step instructions, visuals, demonstrations, extra time, quiet space)
Availability
Embrace is a multi-site business across Canberra and operates 7 days a week. This section helps us understand when you are available and how many hours feel right for you, so we can plan shifts that support your goals, routine and wellbeing.
Which days are you available for shifts?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
What times of day suit you?*

MorningMiddayAfternoonEveningsOutside School Hours only
How many hours per week can you currently work?*
What is your goal for total working hours per week?
Transport
How will you get to and from shifts?*

Independent travelFamily / carer supportPublic transportWill require transport support
Do you have NDIS funding to support transport?

YesNo
Additional Information
This section confirms your understanding of the program and what happens next. It also gives us permission to contact you and begin planning your pathway.
Is there anything else you would like us to know?
Consent
*

I consent to Embrace Disability Group contacting me to discuss this programI understand this is an Expression of Interest and places are offered based on suitability and availability
Should be Empty:

Beyond Embrace – Expression of Interest (EOI) Form