Interchange Inner East

Expression of Interest for programs

Whilst this expression of interest will be logged and reviewed you will not be contacted unless a potential vacancy becomes available.

We are currently accepting expression of interest from age 8 up to 21 years old

Date of enquiry*

Childs Name*

Age*
Ages 8 up to 21 years only

Disability*

Any other medical needs
This includes epilepsy, diabetes, asthma

Ratio for support*
Please consider how your child would need to be supported on a trip to the shops or supermarket.
Do they require 1:1 or 1:2 support or are they more suited to a group?

Behaviours:*
Please advise us of any behaviours that we would need to know about, e.g absconding

Mobility Supports:*
Does your child require mobility supports?

Communication Supports*
Does your child use communication supports?

Funding Type
Please advise us if you have transitioned to the NDIS

Which suburb do you reside in?*

Contact Persons Name*

Contact Person email:*

Contact person phone number*

Please advise us of the programs you are interested in. Please note we are unable to guarantee availability of any of our programs.*

Interchange Inner East has a Host program, are you interested in this?
Information about the Host program can be found on our web page

Is your child of Aboriginal or Torres Straight Islander background?*

Would you like to receive invitations to our Family Events e.g. Twilight Cinema*

Would you like to receive our Newsletter?

Would you like to receive information about planning for the NDIS from us?

Is there anything else you would like to tell us?

Send me a copy of my responses

Email address