The National Disability Insurance Scheme

in Western Australia Conversation meeting on

Friday 9 June and Saturday 10 June 2017

Fill in this form if you want to come

This is an Easy Read version

There are some difficult words. They will be in bold blue. You can ask your

family or carer to explain these to you. You can call 9426 9337 or TTY 133

677, for help with this form. The difficult words are explained on page 6.

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Let’s work together onFriday 9 June and Saturday 10 June 2017

If you want to come along to the meeting you

need to tell us some things about you.

What is your full name?

How old are you?

What is the street number and street name

where you live?

What suburb or town do you live in?

What is the postcode where you live?

2

What is your phone number?

What is your email address?

What disability do you have?

Please put a inside the box if the words

describe you.

I am Aboriginal or Torres Strait Islander.

I was not born in Australia.

I was born in:

______________________________________

I have some allergies and can not eat some

types of food.

I cannot eat:

______________________________________

3

Please put a inside the box that best tells us

what you would like to do.

I want to go to the meeting on both days.

I only want to go to the meeting on Friday 9

June.

I only want to go to the meeting on

Saturday 10 June.

Please put a inside the box of the things you

will need at the meeting:

I will use my wheelchair.

I will bring my assistance dog.

I will bring my support worker.

I will need to be able to get to a quiet area.

I will need an interpreter.

We will talk about the NDIS at the meeting.

What is important to you about the NDIS that

you would like to talk about?

______________________________________

______________________________________

______________________________________

Please send this form to:4

NDIS in WA Conversation, c/o Disability Services Commission, PO Box 441, West Perth WA 6872

Or

NDISinWA.Conversation@dsc.wa.gov.au

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Here are the difficult words.

The National Disability Insurance Scheme is a new way the government will

support eligible people with disability in Australia. We will sometimes say NDIS

when we mean National Disability Insurance Scheme.

When we say allergies we mean food that can make some people sick if they

eat it.

Interpreters help people with hearing impairment, or people who don’t speak

English, to know what is being said and to talk to other people.

When we say support workers we mean people who get paid to help you

when you’re at home and when you’re not at home.

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