Click Here to view our Emergency (COVID-19) Pandemic Plan

Download our Coronavirus Quick Guide here

Click Here to view our Emergency (COVID-19) Pandemic Plan

Download our Coronavirus Quick Guide here

Question 1
Are you aged between 7 and 65?
Yes. Go to the next question.

No. I have a child aged under 7. Find out more about Help for children under 7.

No. I'm over 65. You must be under 65 to access the NDIS. You may be able to access other supports. Find out about NDIS and Aged Care.
Question 1
Question 2
Do you live in Australia and have Australian residency?
Yes. I live in Australia and I am an Australian citizen or have a Permanent or Special Category Visa. Go to the next question.

No. You may be able to access other supports.The NDIS is only available to:
  • People who live in Australia
  • Australian citizens
  • Permanent Visa holders
  • Protected Special Category Visa holders.
  • Question 2
    Question 3
    Do you usually need support from a person because of a permanent and significant disability?
    Yes. You may be eligible. Find out how to apply.

    No. Go to the next question.
    Question 3
    Question 4
    Do you use special equipment because of a permanent and significant disability?
    Yes. You may be eligible. Find out how to apply.

    No. Go to the next question.
    Question 4
    Question 5
    Do you need some supports now to reduce your future needs?
    Yes. You may be eligible. Find out how to apply.

    No. The NDIS may not be the best way to support you. You may be able to access other supports.
    Question 5

    Referral Form

    Referral Form

    Participant Details

    Gender
    Participant is currently;

    Primary Contact

    Participant Information

    Does the participant require medication to be administered during support hours?
    Services Requested by the Participant
    Has the participant consented to this referral?

    Please note, Empowered has a minimum shift length of four hours for all new participants.
    *Participants who require less than a four support will be subject to approval and will depend on the total number of hours of support required per week*

    Preferred Times

    Day

    Start

    End

    Monday
    Monday Start Time
    Monday Finish Time
    Tuesday
    Tuesday Start Time
    Tuesday Finish Time
    Wednesday
    Wednesday Start Time
    Wednesday Finish Time
    Thursday
    Thursday Start Time
    Thursday Finish Time
    Friday
    Friday Start Time
    Friday Finish Time
    Saturday
    Saturday Start Time
    Saturday Finish Time
    Sunday
    Sunday Start Time
    Sunday Finish Time

    Referral Completed By

    Do you give consent for Empowered Community Services to use my image to share on their social media accounts, website & advertisements?
    How did you hear about us? *
    Upload additional information such as participants NDIS plan
    Maximum upload size: 516MB