Referrals

First Name*

Last Name*

Your Email*

Phone Number*

I am a...*
Person with disabilityFamily memberSupport CoordinatorLegal GuardianOther

Who are you referring?*
Select an optionYourselfFamily MemberYour clientOther

Do you/ the individual you are representing, have an NDIS plan?*
YesNoUnsure

What is your / their funding source?*
NDISDSOAICWADepartment of Child ProtectionDepartment of CommunitiesUnsureOther funding source

What services are you looking for?*
Accommodation ServicesCommunity ParticipationAssistance with Daily livingTransportCommunity NursingHome care and Support servicesOthers

How did you hear about us?*
Social mediaGoogleSupport Coordinator / Plan ManagerWord of MouthEmail from Affinity Care WAPost / mailEvent / ExpoRadioOther

Additional comments
This is for our NDIS Supported Independent Living (SIL) accommodation vacancies only. For career related submissions, please complete our contact form.