Participant Details Full Name Your email Mobile Number Date of Birth Residential Address Postal Address Details How do you describe your gender? MaleFemaleOther Are you an Aboriginal or Torres Strait Island descent? NoYes – Aboriginal OnlyYes – Torres Strait Island OnlyYes- Both Language/s Spoken at home Interpreter needed? NoYes Communication Method/Style? VerbalNon-verbalWrittenVisualSign LanguageCommunication Devices Preferences for communication EmailPhoneSMSPost Disability Conditions/Disability type(s) including diagnosis Is there Office of the Public Guardian order in place YesNo Information of Public Guardian Full Name Email Address Phone Number Is there Public Trustee order in place YesNo Information of Public Trustee Full Name Email Address Phone Number Details – Next of Kin Contact (If applicable) Name Relationship Address Phone Number Email Address NDIS Information NDIS Start Date NDIS End Date NDIS Funding Type Plan-managedSelf-managedNDIA-managed
