Long FORM Accommodation Options Expression of Interest Form

Accommodation Options Expression of Interest Form

Everyone has the right to a home where they feel safe, supported, and empowered. Our experienced team is here to support you every step of the way. We’ll help guide you through the process, explore flexible funding options and develop a holistic approach to suit your individual needs. Please fill in your contact details and select your options from the drop-down menus below. We’ll be in touch soon to continue the conversation and help you achieve the housing outcome you’re looking for.
Full Name

First NameLast Name
Name of person seeking support

First NameLast Name
Contact Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What kind of accommodation support are you interested in?
If 'Other,' please provide details:
How did you hear about us?
If 'Other,' please provide details:
In what region are you looking for accommodation support?
If 'Other,' please provide details:
What kind of funding do you have?
If 'Other,' please provide details:
What is your preferred contact method?
Is there anything else you'd like us to know? Please provide details.
Thank you for your interest in Distinctive Options.
The following questions are optional.

Please note: The more information you provide will help us gain a clear understanding of your unique requirements before our next contact with you.
Date of Birth of person seeking support

DayMonthYear
Current living arrangements?
Current Address:

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
What gender are you?
If you have NDIS funding, what is your NDIS number?
If you have NDIS funding, what are your plan dates?
If you have NDIS funding, who manages your plan?
If you have a Support Coordinator, what are their contact details?
If you have a Speech Pathologist, what are their contact details?
If you have an Occupational Pathologist, what are their contact details?
If you have any other Allied Health or specialist support, what are their contact details? (Optional)
Thank you for completing our Accommodation Options Expression of Interest Form. Please click on the submit button below to send this form to our accommodation support team at Distinctive Options.
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Accommodation Options Expression of Interest Form

The following questions are optional.