I am a
Alternate Phone (home or work)
Preferred Contact Method
Genderrequired
Male Female Other
What region would the participant like support in?
Northern Adelaide Eastern Adelaide Southern Adelaide Western Adelaide Other
Please indicate primary disability/diagnosis
What is the participant's funding source?required
NDIS Lifetime Support Authority Return to Work SA Self Funded Other
Does the participant have funding for Supported Independent Living? Please indicate the support ratio the participant is funded at
Yes - 1:1 Yes - 1:2 Yes - 1:3 Yes - Other Currently in progress No
Does the participant have funding for Specialist Disability Accommodation? Please indicate what category the participant is funded at
Yes - Basic Yes - Improved Liveability Yes - Fully Accessible Yes - High Physical Support Yes - Robust Currently in progress No
Does the participant have funding for Community Participation?
Yes No In progress
Is the participant registered on the Community Housing Client Register (CHCR)? Information about the CHCR: https://bit.ly/chcr-housing
Yes No I don't know
Is the participant category 1 eligible on the CHCR? Eligibility criteria for category 1: bit.ly/c1-eligibility
Yes No I don't know
Please provide any additional information about your enquiry Tell us more about the participant's circumstances and why you're interested in this particular home listing.
How did you hear about us?required
Current Client Word of Mouth Google Social Media Website Referral from another organisation Referral from the NDIS Other
Consent