SDA Registration of Interest Form

Date submitted

Name of applicant registering interest for Specialist Disability Accommodation

Enter a current address for the applicant

Enter applicant's date of birth

Enter a contact number for the applicant

Enter the email address of the applicant

Provide information on the type of accommodation that you are currently residing in

Use the dropdown box to select your primary source of income

Use the dropdown box to select if you are currently registered for public or community housing. If you answer yes, please select the category that applies to registration

Enter the name of your NDIS support coordinator

Enter the best contact phone number for your NDIS support coordinator

Enter the email address of your NDIS support coordinator

Select if you have SDA funding approved in your current NDIS plan

Select the design category that you have approved in your NDIS plan

Select the building type that you have approved in your NDIS plan

Enter the location approval for SDA in your NDIS plan

Enter name of your SIL provider

Enter the preferred contact phone number for your SIL provider

Enter email address of your SIL provider

Select whether you have a guardian

Select whether you have a finance manager i.e. Public Trustee

Enter the name of the person completing this registration of interest form on behalf of the applicant

Enter the contact number of the person completing this registration of interest from on behalf of the applicant

Please enter any further relevant details

Proof of Capital Supports funding (SDA Accommodation) in your NDIS Plan can be attached