Participant Suitability Quiz

This short intake form helps our team understand each participant's needs so we can recommend the right supports. All information is kept confidential.

Participant Details

Participant full name *

Date of birth *

Parent / guardian full name *

Parent / guardian phone *

Parent / guardian email *

Independence

Select Yes / Sometimes / No for each.

Can follow simple verbal instructions

Can stay with a group in community settings

Can cross roads safely with supervision

Can manage personal belongings

Can communicate needs when upset or unwell

Personal Care

Tick any supports the participant needs.

Toileting supportChanging clothesEating/drinking supportMedication administrationMobility supportNone of the above

Additional details

Behaviour & Safety

Yes / No for each.

Does your child have a behavioural plan

Yes No

Physical aggression towards others

Yes No

Property damage

Yes No

Running away / absconding

Yes No

Self-injurious behaviours

Yes No

Significant emotional outbursts

Yes No

Police involvement

Yes No

Additional details

Community Access

Which best describes the participant? *

Medical Information

Does the participant have

EpilepsySevere allergiesDiabetesMental health concernsMobility limitationsOther medical conditions

Additional details

Support Requirements

Behaviour Support PlanRestrictive PracticesPositive Behaviour Support PlanAllied Health TeamSupport Coordinator

Development Goals

Making friendsBuilding independenceCommunity participationTravel trainingConfidence buildingLife skillsRecreation and social connection

Other goal

Group Suitability

Can the participant safely participate in community-based activities with a ratio of approximately 1 support worker to 2–4 participants? *

Yes No Unsure

With George

With George delivers inclusive NDIS social groups, afterschool programs and life skills support for young people with disability and neurodivergence across Sydney.

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