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Mental Health Statement of Coorporation

© Copyright 2020 Empowered Community Services | Terms and Conditions

Empowered Community Services Pty Ltd
ACN: 634 541 076 | NDIS Provider Number: 4050060444

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
Make a Referral
Contact Us
Our Services

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
Make a Referral
Contact Us
Our Services

Referral Form

Referral Form

Participant Details

Gender *
Does the participant identify as Aboriginal or Torres Strait Islander? *
Participant is currently;
Additional Details

Primary Contact

Participant Information

Does the participant have a secondary disability?
Does the participant have any allergies?
Does the participant require medication to be administered during support hours?
Does the participant have a companion card?
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

Details

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

Referral Completed By

Risks
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

Team Leaders

We encourage all participants to be assigned a Team Leader from Empowered. Our Team Leaders can help with tracking participant goals, developing strategies to assist with support, communicate strategies with staff, and develop reports as requested. If you do not wish to be allocated a Team Leader please notify our administration staff.