Expression of Interest Form
Your name
*
First Name
Last Name
Your date of birth
*
/
Day
/
Month
Year
Date
Your email
*
example@example.com
Your contact number
*
Your preferred method of contact
Phone
Email
In person
Teams Meeting
What supports or events are you interested in?
*
Support Work in the home or community
Social Groups
Workshops/Training
Counselling
Support Coordination
Other
Please tell us below which group or workshop you're interested in.
Days you are wanting supports
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred time for support
7am - 9am
9am - 3pm
3pm - 8pm
Overnight active/passive
Other
Which specific support needs do you have?
*
I have a Positive Behaviour Support Plan
I need 2:1 support
None
Other
Do you already receive supports from Bright Star?
*
Yes
No
Are you an NDIS participant OR are you completing this form on behalf of an NDIS participant?
*
Yes
No
Your relationship to the NDIS participant
*
Self
Parent/Caregiver
Support Coordinator
NDIS Plan Nominee
Other
NDIS participant's name
First Name
Last Name
NDIS participant's date of birth
/
Day
/
Month
Year
Date
Do you have any specific requests or comments for us?
You can also tell us here if you have an idea for a social group or workshop you'd like to see!
Submit
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