NDISP SDA Property

Retrieve Existing Application

Please read this before completing the Application for Specialist Disability Accommodation form

About this application form

This form is to be used by National Disability Insurance Scheme (NDIS) participants wishing to apply for a vacancy in NDISP (SDA).

Who can apply for SDA vacancy?

 A person who is a NDIS participant and has eligibility for SDA confirmed in their approved NDIS plan.

 A person who is waiting for their eligibility for SDA to be confirmed by the NDIA (either waiting on a plan review or outcome of assessment for SDA eligibility).

Important information for applicants / support network / support coordinators

 The application should be accompanied by documentation that supports statements about the applicant’s support needs, for example housing assessment report or SDA approval.

 Completed applications, including SDA application form, signed consent page and any supporting documentation, are to be submitted as part of this application

 Applications should be submitted electronically wherever possible.

 Insufficient or inaccurate information may impact on the offer of residency, including withdrawal of offers made on the basis of inaccurate information provided in the application form.

 Applicants will be advised if they are the preferred applicant for the vacancy, however an offer of residency will not be made until the applicant’s eligibility for SDA is confirmed by the NDIA. It is the responsibility of the applicant to have their eligibility for SDA confirmed.

 This application is for SDA only, not for SIL (Supported Independent Living)

 This application may be shared with relevant care providers to discuss tenant matching

 All applicants understand that this application will form the initial basis of decisions about whether the applicant is suitable for an NDISP house

 The application is subject to the required level of SDA being approved on the applicants plan

 A provisional offer can be made prior to SDA being secured

Specialist Disability Accommodation Application Form

Section 1: Applicant information

Property address applying for: *

Date of application *

Personal Details

Salutation *

First Name *

Last Name *

Email *

Date of Birth *

Gender *

Mobile *

Is the participant their own decision maker? *

Primary Disability

Other Disability

Preferred Language *

Interpreter required *

Indigenous status

NDIS Participant number *

Is Specialist Disability Accommodation (SDA) eligibility confirmed in your approved NDIS plan? *

If Yes, please specify

Plan Start Date:

Plan End Date:

SDA Building type

SDA Design category

SDA Amount Approved

If No, you will need to request a plan review or seek your SDA eligibility urgently

If No, please specify reason (i.e still seeking SDA eligibility, still waiting for a plan or still waiting for a plan review)

Support Co-ordinator’s details if applicable

Support Coordinator’s - name

Support Coordinator’s - Organisation name

Support Coordinator’s - Phone number

Support Coordinator’s - Email address

Section 2: Primary contact person/Guardian (This should be someone other than the participant )

Primary contact - First name

Primary contact - Surname

Primary contact - Relationship to participant

Primary Contact - Address, Suburb, Postcode

Primary Contact - Business Hours Phone

Primary Contact - Mobile

Primary Contact - Email

Section 3: Next of Kin, Emergency Contact

Is your next of kin the same as your primary contact person?

If no, please fill out your next of kin details below

Next of Kin - First Name

Next of Kin - Surname

Next of Kin - Relationship to Participant

Next of Kin - Business Hours Phone

Next of Kin - Mobile

Next of Kin - Email

Section 4: Plan Management

Please choose how your plan is managed *

Plan Manager - Organisation *

Plan Manager - Business Hours Phone

Plan Manager - Email for Invoices

Section 5: Decision maker - EPOA Guardian and / or financial administrator

Do you have a legal Guardian/ Financial Administrator or EPOA?

Accommodation

Health

Lifestyle

Services

Guardian - FIrst Name

Guardian - Last Name

Guardian - Organisation if applicable

Guardian - Phone

Guardian - Email

Financial Administrator - First Name

Financial Administrator - Last Name

Financial Administrator - Organisation if applicable

Financial Administrator - Phone

Financial Administrator - Email

Financial Administrator - Reference Number if applicable

Section 6: Understanding about you

6.1 Tell us about yourself – (i.e what are your likes and dislikes, anything important that the Housing Provider should know about you)

6.2 How would someone you know describe your personality?

6.3 Do you have any particular interests or hobbies?

6.4 Do you have any preferences about who you would like to live with (i.e gender, age, interests, or cultural background)

EPOA -First Name

EPOA- Last Name

EPOA - Organisation If Applicable

EPOA- Phone

EPOA- Email

Section 7: Understanding your support needs

How do you prefer to communicate

How do you prefer to communicate *

Verbally

Auslan

Makaton

Combination of Auslan Makaton

Non verbal vocalize

Point gesture

Ipad

PECS

Other communication methods:

Do you use or require any equipment? *

If Yes, describe. Especially if there is a technology you use such that may benefit from integration with the automated systems in our homes: e.g. communication devices, tech devices that allow you to …

Do you have any special requirements that building maintenance staff would need to be aware of before entering your home?

Do you require support due to any of the following behaviours?

I have no behaviours of concern that require specific support *

Other:

Do you have a risk assessment relating to any of your behaviours or support needs (i.e fire risk assessment)? *

If yes, please attach

Who completed the assessment?

Assessment date

What mode of transport do you mainly use to travel to and from places? *

Is there any other information you would like to add?

Personal Details

By submitting this application you are agreeing to the following terms,

You or your authorised representative* must provide consent for the Specialist Disability Accommodation (SDA) application and information provided in the application (and requested assessments and reports) to be used in the following ways:

· To create a file (electronic and/or paper)

· To be seen by external agencies for a SDA vacancy

· For statistical reporting (information is de-identified)
* Your representative could be a primary carer, family member, advocate or an appointed guardian. A paid worker such as a case manager or support worker cannot be your representative.

I have been informed and consent to the use of information in the application for any Specialist Disability Accommodation dwelling vacancy that I am applying for. I understand that this information may be provided to external agencies for this purpose. I also understand that this consent allows for information in this application to be used for statistical reporting.

By submitting this form I declare that I have provided all information relevant to my application for SDA and the information given on this form is true and correct to the best of my knowledge.

If submitting by a person other than the Participant. By submitting this form I declare that I have discussed the purpose and disclosure of this information with the applicant or their representative and I am satisfied that they understand how the information will be used, and that they have provided informed consent to the submission of this application for support.