Access Request Form

Information required to be completed by the Participant:

• Personal Details
• Your privacy and consent to collect and share your information
• How would you like the NDIA to contact you?
• Parent, legal guardian or representative details (if applicable)
• Information about your carers and family members (if applicable)
• Your disability, or need for early intervention supports
  • Always list the disability that has the most affect on your daily functional life first.
  • Then list the disabilities that affect your functional abilities on a daily basis. 
    • These need to be listed in order of most affect on your functional abilities on a daily basis to least.
  • It is also worth listing major functional limitations (Secondary conditions)
• The section “We need supporting information about your disability and the impact it has on your mobility, communication, social interaction, learning, self-care and/or ability to self-manage.”
  • If possible this is best completed by a Professional, for example
    • General Practitioner
    • Medical Specialist
    • Paediatrician
    • Psychologist
    • Psychiatrist,
    • Educational Professional, etc