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Supported
Independent
Living (SIL) Enquiry Form
Guest's First Name
*
Guest's Last Name
Email
*
NDIS Plan start date
*
Day
-
Month
-
Year
NDIS Plan end date
*
Day
-
Month
-
Year
Has the Guest previously lived or currently living in SIL accommodation?
*
What ratio of support is the guest funded for? If not yet funded, anticipated funded ratio.
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1:1
1:2
1:3
Other
Does the guest have SIL funding outlined in their NDIS plan or is it currently being reviewed to be established in a new plan?
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Yes, currently funded for SIL
Yes, currently under review
In progress, currently under review
No, about to begin the process
Does the Guest have any mobility requirements?
No mobility requirements.
Yes - minimal mobility requirements. i.e., struggles with stairs.
Yes - moderate mobility requirements. i.e., has a walking aid.
Yes - major mobility requirements. i.e., wheelchair requirements.
Provide goals outlined in the Guests NDIS plan?
Is there a current Positive Behaviour Support Plan (PBSP) in place?
*
Yes
No
In the process of obtaining a PBSP
Yes but has expired
If answered yes to Question 6, please upload a copy of the PBSP.
Are there any behaviours of concern when out of home eg. absconding, non compliance, challenging authority, safety around roads?
*
Does the Guest interact with others? Do they demonstrate socially appropriate behaviours in social situations?
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Yes
Most of the time
Sometimes
Struggles
If struggles in social situations, please provide more detail.
Do you have an anticipated schedule of service or outline of the services you will require?
*
Is there any other information you would like provided or to provide?
Submit