Home / EligibilityEligibilityEligibility Form Please complete this form to determine your eligibility for receiving services from Sync Support Care. Your responses will remain confidential and will be used solely for assessing your eligibility. PhoneThis field is for validation purposes and should be left unchanged.Personal Information:First Name*Last NameDate of Birth* Gender* Male Female OthersAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone Number*How Did You Hear About Us?Select OptionSocial Media (Facebook, Instagram, etc.)Word Of Mouth/ReferralOtherEmail Address* 1. Are you impacted by any disability?*Please indicate whether you have a disability that impacts your daily life and requires support. Yes No2. NDIS Participant Status:*Are you currently an NDIS participant or have you applied for the NDIS? I am already an NDIS participant. I have applied for the NDIS. I am not an NDIS participant and have not applied.3. NDIS Number (if applicable):Please provide your NDIS number if you are already an NDIS participant.4. Support Category:* Specialised Disability Accommodation (SDA) Respite Care Supported Independent Living (SIL) Accommodation and Tenancy Services Community Participation Support Coordination School Leavers Employment Support (SLES) Disability Employment Services (DES) Other (Specify)5. Funding Plan:*Do you have an NDIS funding plan in place? First Choice Second Choice Third Choice6. Goals and Needs:Briefly describe your main goals and the specific support needs you are looking for.7. Medical and Health Information:Please provide any relevant medical or health information that may impact the services you require.8. Additional Information:Is there any additional information you would like to share about your situation or needs?9. Permission to Contact NDIS:*Do you grant us permission to contact the NDIS on your behalf to verify your eligibility and funding status? Yes No10. Are you of Aboriginal and/or Torres Strait Islander origin?* Yes No11. Preferred Contact Method:*How would you prefer to be contacted regarding your eligibility assessment? Phone Email12. Consent to Data Collection:*By submitting this form, you consent to the collection and use of your personal information for the purpose of assessing your eligibility and providing relevant services. I consentAttachments Drop files here or Select filesMax. file size: 256 MB.13. Signature:Please write your name to confirm your submission.Thank you for completing the eligibility form.Our team will review your information and contact you shortly to discuss your eligibility and next steps. For any immediate questions, please contact our customer support at 0435 892 933
