Please read before completion
About this application form
This form is to be used by Civic for people wishing to apply for the following services with Civic:
• Supported Employment — Finding and keeping a job
• School Leaver Employment Supports (SLES)
• Centre Based Activities (Hubs)
• Community and social activities (Groups and Supported Holidays)
Who can apply for Services with Civic?
• A person who is over 18 with a current NDIS plan and applicable funding for the service requested.
• A person who is over 18 but does not have a NDIS plan but may wish to pay directly for the service.
Important information for applicants/support network
• Please complete all sections of this form. It is essential that ALL information is as detailed and accurate as possible to fully assess the support requirements of the applicant.
• The application should be accompanied by documentation that supports statements about the applicant’s support needs, for example behaviour support plans, health care plans and personal care plans.
• Once form is completed, including the signed consent page, please attach any supporting documentation and submit to firstname.lastname@example.org via email wherever possible. If this is not possible, please contact the Customer Experience Team directly to discuss submission.
• A member of the Customer Experience Team may contact the person nominated on the form in (Section 3) if further information is required to support the application.
• Insufficient or inaccurate information may affect the offer of services, including withdrawal of offers made based on inaccurate information provided in the application form.
• Applicants will be contacted by our Customer Experience Team to advise you of the progress of your application and to advise of any necessity to further assess the suitability of the applicant.
• Contact the Customer Experience Team (1300 692 484) if you have any questions regarding this form.