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.
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.

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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