Referral Form

Thank you for choosing Empowered Community Services.

Once complete, the referral form will be sent to the most appropriate person, who will be in touch to discuss your support needs.

Referral Form

Participant Details

Gender *
Does the participant identify as Aboriginal or Torres Strait Islander? *

Participant Information

Services Requested by the Participant

Referral Completed By

How did you hear about us? *
Upload additional information such as participants NDIS plan
Maximum upload size: 516MB

Team Leaders

Participants receiving Community Access and Capacity Building Supports will be assigned a Team Leader. Our Team Leaders can help with tracking participant goals, developing strategies to assist with support, communicating strategies with staff, and developing reports progress reports. Team Leaders will be charged under the Non-face-to-face line item as necessary.

Establishment Fee

Participants with more than 20 hours of support per month may be charged an establishment fee when entering the service.

Current Capacity

WE HAVE CAPACITY !

Community Access & Capacity Building

0 Hours

Support Coordination

0 Participants

Specialist Support Coordination

0 Participants

School Leavers Employment Program

0 Participants

Current Capacity

WE HAVE CAPACITY !

Community Access & Capacity Building

0 Hours

Support Coordination

0 Participants

Specialist Support Coordination

0 Participants

School Leavers Employment Program

0 Participants

Referral Form

Referral Form

Participant Details

Gender *
Does the participant identify as Aboriginal or Torres Strait Islander? *

Participant Information

Services Requested by the Participant

Referral Completed By

How did you hear about us? *
Upload additional information such as participants NDIS plan
Maximum upload size: 516MB

Team Leaders

Participants receiving Community Access and Capacity Building Supports will be assigned a Team Leader. Our Team Leaders can help with tracking participant goals, developing strategies to assist with support, communicating strategies with staff, and developing reports progress reports. Team Leaders will be charged under the Non-face-to-face line item as necessary.

Establishment Fee

Participants with more than 20 hours of support per month may be charged an establishment fee when entering the service.