Expression of Interest — Melbourne Deaf Club

✓Eligibility Check Questions

Are you 18 years of age or older?*

Yes No

Do you identify as Deaf, deaf or hard of hearing?*

Yes No

Do you have an active NDIS plan?*

Yes No Not sure

Do you have NDIS funding that may be used for support to participate in social or community activities?*

Yes I believe so I am not sure No

Which days are you available to attend?

Sunday Saturday Either Saturday or Sunday Not Available on both days

Can you travel to and from the activity or meeting location independently?

Yes Usually, but I may occasionally need assistance No

What support needs do you have during community activities?

None of the below Personal care assistance Medication administration Behaviour support Clinical or nursing support Continuous 1:1 supervision Mobility assistance

👤Personal Details

Full Name*

Preferred Name

Date of Birth*

Melbourne Suburb*

Email Address*

Mobile Number

NDISNDIS Contact Information

What type of NDIS funding management do you have?*

Self-managed Plan-managed NDIA-managed Combination of the above I am not sure

Plan Manager Name

Plan Manager's Email Address - If you consent

Do you consent to us contacting your Plan Manager to confirm whether this service can be funded?

Yes No I would like to discuss this first

MDC will use this information to understand how your NDIS support is managed and, where you consent, to communicate with your Plan Manager about whether the service may be funded.

🎯Activity Preferences

Activities you definitely do not want to participate in

Which type of activities do you prefer?

Mostly Social Mostly Active Mostly Relaxing A mixture No Preference

🧏Support & Accessibility

What would help you participate comfortably?

Auslan communication Visual instructions Captions Smaller group Quiet environment Extra explanation before activities Help communicating with venue staff Help meeting or socialising with other participants Mobility or accessibility requirements

Anything else MDC should know to help you participate safely?

💬Contact Consent

Preferred Method Of Contact

Email SMS Video Call (Facetime) Phone Call

Preferred Communication Method

Email SMS or text Auslan Written English Captions Visual instructions Lip-reading or spoken communication

Consent to be contacted by Melbourne Deaf Club*

Select the reasons you agree MDC may contact you.

Select all Eligibility and enrolment Upcoming activities Changes or cancellations Service documents Participation in MDC

Privacy acknowledgement*

I acknowledge that my information will be used to assess service suitability, contact me about enrolment, and organise community participation services I acknowledge that Melbourne Deaf Club will only collect and use information reasonably required for those purposes

You're almost done.

Please review your answers before submitting your Expression of Interest. Completing this form does not automatically confirm enrolment or a place in an activity.

Tell us what would make your weekends better.

Melbourne Deaf Club – Expression of Interest

✓Eligibility Check Questions

👤Personal Details

NDISNDIS Contact Information

🎯Activity Preferences

🧏Support & Accessibility

💬Contact Consent

You're almost done.

Thank you — your EOI has been submitted.