Habitability NDIS STA Quote Approval Form

Name(Required)

First Last

Email(Required)

Phone(Required)

Who is making the enquiry?(Required)

Was STA declined as a support in your NDIS Plan?(Required)

Either at the planning meeting or advised by an LAC or NDIS Delegate?

Hidden

Will you be bringing a paid support worker

Please note, if you are planning to travel alone the NDIA require evidence that independent travel will be safe and appropriate

Hidden

The NDIS require supporting evidence to fund independent travel

Are you happy to proceed with this in mind?

Yes i am

Destination and preferred area?

Hidden

Number of rooms required?

Hidden

Purpose of STA

Activity Based

Respite

Check In

Check Out

Are your dates flexible?

Yes

Accept our Terms and Conditions(Required)

Accept our Terms and Conditions

Habitability NDIS STA Quote Estimate Approval Form