Everything we do is driven by our members, for the benefit of our members.
By telling us a bit about your needs it will help us establish your needs and requirements. We shall call for members in March 2017 and launch our on-line ‘discuss & connect’ platform.
start
 
For the purpose of this form, we will assume all the details provided are for the person with disability. If you are filling this out of behalf of a person with disability, please provide their details and not your own unless specified.
Thanks!

 
General details about the person with a disability.

 
What's your (person with disability) first name? *

 
Hey {{answer_40320700}}, nice to meet you.
What's your last name? *

 
Date of birth *

 
Gender *

 
Please describe the disability type

 
The person with a disability is most interested in:


 
Details about the housing needs of the person with a disability

 
Current postcode for the person with a disability

 
State where the person with disability wants to live


 
Region suburb or postcode where person with a disability wants to live.

 
How urgent is your need for housing? *


 
NDIS Information

 
Is the person with disability a current NDIS participant?


 
If YES - What is your NDIS number?
If NO - when do you expect the First NDIS Plan?

If you're unsure, just write 'unsure;
 
Other details that maybe relevent

 
Next steps

 
A contact phone number *

If the contact number is for a family member or carer, please provide a name.
 
Would you like to receive a phone call from SILC? *

     
 
Would you like to meet face-to-face with someone from SILC? *

     
 
If you would like to meet face to face, where do you live?

If NO - please write 'no'
 
Would you like us to stay in contact with you? *

     
 
How did you hear about SILC? *


 
Thank you for completing our EOI form.


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