Are you a Support Coordinator, Carer or Family member or Participant completing this form?*
Choose an optionSupport coordinatorCarerFamily memberMyself

Contact person

Service Types
Supported Independent LivingShort Term Accommodation/ Respite SupportSpecialist Disability AccommodationCommunity Participation

Email*

Phone*

Number of bedrooms (depending on if your carer or support worker is attending the STA with you)*
Choose an optionOneTwo

Additional requirements
Ground Floor Accessible RoomPick up/Drop offParkingSpecialised EquipmentWheelchair AccessibleNone of the above

Please specify any other requirements including dietry