Samaritans NDIS pre-planning tool...36 Warabrook Boulevard, Warabrook NSW 2304 PO Box 366, Hunter...
Transcript of Samaritans NDIS pre-planning tool...36 Warabrook Boulevard, Warabrook NSW 2304 PO Box 366, Hunter...
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Samaritans NDIS pre-planning tool
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About me 4
My relationships 5
My support 6
My weekly needs 7
My goals 9
Contents
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1. About me
My Name: ______________________________________________________ My age: ____________
My address: _________________________________________________________________________
___________________________________________ State: ____________ Postcode: ____________
Who I live with: _______________________________________________________________________
The best way to contact me: P: ________________________________________________________
E: ________________________________________________________
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S a m a r i t a n s N D I S P r e p l a n n i n g w o r k b o o k 5
2. About my relationshipsWho are the important people in your life?This might include:• Friends• Family• Support workers• People from your work, school or day program
Name Relationship (family/paid supports/friends)
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3. About my supportsWho currently provides you with support? This might include:• Your family• Your friends• Health Services• Teachers aid• Public Guardian
Support/Person Name How they help me How often they help me
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S a m a r i t a n s N D I S P r e p l a n n i n g w o r k b o o k 7
4. What does your week look like?
Day What I do What help I need
Example Go to school and go swimming after school
Help with getting ready for school, support worker to go with me to swimming lessons
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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5. What equipment do you currently use or think you might need?This might include a wheelchair or orthoses.
Equipment
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6. What are your goals for the next 12 months?
Goal
Example: To develop my speech
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7. What are your long term goals?
Goal
Example: To gain independent living skills
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8. How much help will you need to put your plan in to action?Who might be able to help you with it?
Example: ‘I will need help to source service providers, my mum can help me’ or ‘I will need a lot of help, I don’t have anyone to help me’.
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Samaritans Foundation - Diocese of Newcastle36 Warabrook Boulevard, Warabrook NSW 2304
PO Box 366, Hunter Region Mail Centre NSW 2310P: 1300 656 336 E: [email protected]