NDIS Enrolment

Enrol a Participant

Complete this form to enrol an NDIS participant in a Capacity Builders program. Login credentials will be emailed to the participant upon enrolment.

Participant Details

Personal details of the NDIS participant being enrolled.

Full Name (First & Last) *

Preferred First Name *

Email Address *

Phone Number *

Street Address *

Suburb *

Postcode *

State *

Date of Birth

Funding and plan information used for invoice generation.

NDIS Plan Number *

Funding Type *

NDIS Plan Start Date

NDIS Plan End Date

Plan Manager Company / Invoice Contact Name *

Plan Manager / Invoice Contact Email *

Select the program and NDIS line item for this enrolment.

Program *

NDIS Line Item / Support Code *

Details of the person submitting this referral.

First Name *

Last Name *

Phone Number *

Email Address *

Optional details to help us support the participant.

How did you hear about us? *

Disability and Driving Support

I agree to the Terms & Conditions of this program and confirm I have the participant's permission to provide their personal information.