NDIS Policy and Procedure Acknowledgment Form
NDIS Policy and Procedure Acknowledgment Form
Full Name of Participant or Guardian
*
First Name
Last Name
Role
*
Participant
Guardian
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
NDIS Participant Number (if applicable)
Date of Acknowledgment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I confirm I have received a copy of the relevant NDIS policies and procedures.
*
Yes
No
I have read and understood the NDIS policies and procedures provided.
*
Yes
No
I agree to comply with and follow all relevant NDIS policies and procedures.
*
Yes
No
Please provide your signature to confirm your acknowledgment.
*
Submit Acknowledgment
Submit Acknowledgment
Should be Empty: