NDIS Assistive Technology Request Form
Submit your request for assistive technology under NDIS. Please complete all sections accurately to ensure your request is processed efficiently.
Applicant Full Name
*
First Name
Last Name
Applicant Email Address
*
example@example.com
Applicant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
NDIS Participant Number
*
Applicant’s Role
*
Please Select
Participant
Parent/Guardian
Support Coordinator
Plan Manager
Other
Describe the Assistive Technology Requested
*
Reason for Request (How will this assistive technology support the participant?)
*
Upload Supporting Documentation (e.g., quotes, reports, recommendations)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
NDIS Plan Status
*
Active
Pending
Review in Progress
Submit Request
Should be Empty: