Housing with Support Application Form

Description

Thank you for your interest in applying for Housing with support from Mind Australia.

In this form, we will ask you to provide information that will help us assess your eligibility for Mind's Housing with support services. The more information you can provide, the faster we will be able to process your application. Please note that we will send you an email when you complete this form.

If you have any questions, please call Mind Connect on 1300 286 463 or email Mind Connect at housingwithsupport@mindaustralia.org.au

Housing with Support Service Summary

Mind Australia offer 3 types of Housing with support services. It is important you understand what you are applying for before completing our application form. You can click here to learn more about these services. A brief summary of our Housing with support service types, and an initial eligibility screening is included below.

The Haven Foundation - integrated social housing and support:

Long term social housing with on-site support for people with mental health and wellbeing concerns who need support to live independently
Each resident has their own self-contained 1-bedroom apartment with a bathroom, kitchen, lounge room, European laundry and outdoor space
Applicants must be registered or eligible for social housing in their state. If you are applying for services in Victoria, you can click here to see the eligibility criteria for the Victorian Housing Register (VHR). If you are applying for services in South Australia, you can click here to see the eligibility criteria for South Australian Housing Trust.

Psychosocial Residential Rehabilitation (PRR):

Housing with support for people with mental health and wellbeing concerns who want to build their skills to live independently and work towards their wellbeing and recovery goals
Most PRRs have shared amenities (kitchens and bathrooms) and stairs. Residents always have a private bedroom. The exact layout varies between sites. There are individual descriptions available on our website: https://www.mindaustralia.org.au/housing-with-support

Housing with support for people with complex needs:

Long term housing with support for people with multiple or complex disability support needs who also require support for their mental health and wellbeing
Applicants for Melton South, Sunshine and White Hills must be eligible for Specialist Disability Accommodation at a “Robust or Improved liveability” level in their NDIS plans
Applicants for Werribee Complex Care do not require Specialist Disability Accommodation (SDA) funding

Applicants for all services:

Must have, or be about to receive, an NDIS plan. You do not need to have Supported Independent Living (SIL) funding in your NDIS plan but must have documentation as evidence that you need in home support
Must be between 18-64 years of age
Must be willing to sign a service agreement with Mind Australia to purchase support around activities of daily living (ADL) and capacity building, based on your NDIS goals
Must be comfortable with living alongside other people and contribute to creating a safe and respectful community
Must have adequate funds to pay for rent and utilities

Housing with Support Application Form (Page 2)

Initial Eligibility Screening

Please answer the below questions to confirm initial, high-level eligibility for our Housing with support services

Eligibility Question 1 - Are you an NDIS participant? *

YesNo

Residents use their NDIS funding to pay for their support at our Housing with support services.
To learn more about NDIS eligibility, you may click here to visit the NDIS website.

If you would like to speak to us about our eligibility requirements, please call Mind Connect on 1300 286 463 or email Mind Connect at housingwithsupport@mindaustralia.org.au

Eligibility Question 2 - Are you over the age of 18? *

YesNo

You must be over the age of 18 to live at our Housing with support services. You may apply if you are close to turning 18 but your application will not be considered until you are 18.

If you would like to speak to us about our eligibility requirements or inquire about our youth residential rehabilitation services, please call Mind Connect on 1300 286 463 or email Mind Connect at housingwithsupport@mindaustralia.org.au

Eligibility Question 3 - Are you willing to sign a service agreement with Mind Australia to purchase support around activities of daily living, as well as sign a separate tenancy agreement for your accommodation, and pay for your rent and utilities? *

YesNo

Residents at our Housing with support services must be willing to sign a service agreement with Mind Australia to purchase support around activities of daily living (ADL) and capacity building. They must also sign a tenancy agreement for their accommodation and pay for their rent and utilities. Residents use their personal income to pay for their rent, utilities and living costs.

If you would like to speak to us about our eligibility requirements, please call Mind Connect on 1300 286 463 or email Mind Connect at housingwithsupport@mindaustralia.org.au

Eligibility Question 4 - Are you registered on, or eligible for, social housing in your state? *

YesNo

Please note that you must be registered or eligible for social housing to apply for any Haven residence, Ascot Vale PRR, Clifton Hill PRR or Werribee Complex needs.

If you are applying for services in Victoria, you can click here to see the eligibility criteria for the Victorian Housing Register (VHR). If you are applying for services in South Australia, you can click here to see the eligibility criteria for South Australian Housing Trust.

If you are not eligible for social housing, you may apply for most of our Psychosocial Residential Rehabilitation (PRR) services or Complex needs services.

If you would like to speak to us about our eligibility requirements, please call Mind Connect on 1300 286 463 or email Mind Connect at housingwithsupport@mindaustralia.org.au.

Eligibility Question 5 - Do you have a recent functional capacity assessment or housing assessment conducted by an allied health professional (e.g. an Occupational Therapist report) that you can submit with your application? *

YesNo

To review your application, we ask for a recent functional capacity or housing assessment that was completed by an allied health professional. Most commonly, this would be a report from an Occupational Therapist (OT). These reports help us understand your needs and support your application.

If you do not have one, please contact us to discuss. You can call Mind Connect on 1300 286 463 or email Mind Connect at housingwithsupport@mindaustralia.org.au

Housing with Support Application Form (Page 3)

Thank you for completing this initial eligibility screening.

If you have answered no to any of the questions, please contact Mind Connect to discuss your initial eligibility for our Housing with support services before completing the intake form.

You can call Mind Connect on 1300 286 463 or email Mind Connect at housingwithsupport@mindaustralia.org.au

You may click to the next page to complete an application for our housing with support services

Housing with Support Application Form (Page 4)

Intake Form

In order to process your application, we will need to ask about personal information.
Please read Mind Australia's data and privacy policy and The Haven Foundations tenancy privacy statement.

Question 1a - Do you agree to sharing your personal information with us? *

Yes

Question 1b

We do research at Mind to understand how to better support people accessing our services, demonstrate our impact to funders, and advocate for the people using our services. Kindly note that we will de-identify any information you provide by removing any personal details that can be used to recognize you (e.g., your name, date of birth). Only your de-identified information will be used in research.

Please indicate if you agree for your de-identified information collected during this Housing with support application process to be used for research and evaluation purposes by Mind Australia.

Question 1b - Do you agree for your de-identified information to be collected for research and evaluation purposes by Mind Australia? *

Yes, I agreeNo, I don't agree

Question 2 - Who is completing this form? *

I am completing this application for myselfI am a professional completing this application on behalf of someone else, with their consentI am a family member or friend completing this application on behalf of someone else, with their consent

Question 2a - Please provide your contact details. This should be the details of the person completing this form.
Details of the person who is applying for our services can be added in the next section.

Q2a1 - Full name of person completing this form *

Q2a2 - Relationship to applicant *

Q2a3 - Phone number *

Q2a4 - Email address *

Q2a5 - Organisation you work for *

Question 2b - Please provide your contact details. This should be the details of the person completing this form.
Details of the person who is applying for our services can be added in the next section.

Q2b1 - Full name of person completing this form *

Q2b2 - Relationship to applicant *

Q2b3 - Phone number *

Q2b4 - Email address *

Question 3 - Please provide the contact details of the person applying for Housing with support

Q3a - What is the full name of the applicant? *

What is your preferred name?

Q3b - What is your date of birth? *

Q3c - What is your Address? *

Street address *

City

State

Postcode

If you don't have one, please write NA in the Street Address field

Q3d - What is your phone number? *If you don't have one, type 0

Q3e - What is your email address? *If you don't have one, type NA

Question 3f - Please describe

Question 3g2 - Please describe

Q3h - Do you identify as Aboriginal and/or Torres Strait Islander *

YesNoBothPrefer not to say

Q3i - What is your country of birth? *

Q3j - What is your preferred language? *

Q3k - What is your primary income source? *

Disability Support PensionOther Centrelink benefitSalary/WageOther

Housing with Support Application Form (Page 5)

Below is a list of all Mind’s Housing with support services.
Please select which Housing with support services you are interested in applying for.

You may either select not interested or leave the row blank for any services you are not interested in.

Information about each of our Housing with support services, and their location, is available on our Housing with support webpage and on our service finder map.

Q4Pref1 - Preference #1 *

Q4Pref2 - Preference #2

Q4Pref3 - Preference #3

Q4b - Please select below if you need Housing with support as soon as possible and are open to being contacted about sites you have not listed on your application

I am open to considering other Mind Australia Housing with support services in the Greater Melbourne areaI am open to considering other Mind Australia Housing with supports service in Victoria

Housing with Support Application Form (Page 6)

Q5 - Are you registered on your state’s social housing register? *(e.g. Victorian Housing Register or South Australian Housing Trust)

Please note that being on or eligible for the public/community housing register is a requirement when applying for any Haven residence, Ascot Vale PRR, Clifton Hill PRR or Werribee Complex needs. If you’re unsure about eligibility, you can click here to see the eligibility criteria for the Victorian Housing Register

Q5b - What is your registration number?

Q6 - Do you have any physical accessibility requirements for your home (e.g. you require ground floor unit, you use a shower chair)?

YesNo

Q6b - Please tell us more about physical accessibility requirements for your home

Q7 - Do you currently have a pet that you would like to live with at the Housing with support service?

YesNo

Q7b - Please tell us more about the kind of pet you have

Q8b - What is your reason for leaving your current accommodation? *

Q8d - What is your reason for leaving your previous accommodation?

Q9 - Have you been in hospital (private or public) or stayed in clinical subacute residential service in the last 2 years? (E.g. Prevention and Recovery Care Centre PARC, Community Care Unit CCU, Secure Extended Care Unit SECU) *

YesNo

Q10 - Please select which support types you're interested in receiving from Mind Australia from the list below. *

Assistance with Daily Life support (e.g. support with cooking, cleaning, medication, routine, personal care, budgeting, planning)Community participation support (e.g. support with shopping, attending appointments)Inactive overnight support (Staff member that sleeps onsite and can be woken for support, if needed)Unscheduled support (Staff being available for unplanned support when you need it. The cost of this support is shared between residents) Group activities

You may select multiple options

Q11 - Please tell us about the support you would like to receive from Mind Australia staff.This could include any preferences you have for how support is provided, or any support needs that are not covered in the documents you provide with your application

Q12 - Please tick if you require support with any of the below areas. *We ask this to help us understand how to best support you and others in a safe and respectful way. This information helps us to know whether we can meet your needs and provide the right environment and assistance for you and others to feel safe and supported in your home.

Q12a - If you have selected any of the above, please provide further information to help us understand how we can best support you

Housing with Support Application Form (Page 7)

Please provide the details of your formal and informal supports that you give consent for Mind Australia to contact about your application.

Full name of support person

Relationship to applicant

Phone Number

Email Address

Housing with Support Application Form (Page 8)

Residents at our housing with support services use their NDIS funding to pay for their support with us.

Please provide some information below about your NDIS funding

Q14a - What is your NDIS number?

Q14b - What is your current NDIS plan START date?

Q14c - What is your current NDIS plan END date?

To help us understand your budget for support with Mind Australia, please provide your NDIS plan with the link below

Browse

If you do not wish to share your NDIS plan with us now, you do not have to. We will discuss NDIS funding requirements with you when we review your application

Q14d - What are your NDIS goals?

Q14g - Do you have funding for Specialist Disability Accommodation (SDA) in your NDIS plan?

YesNo

Q15b - What other way did you hear about our Housing with support services?

Housing with Support Application Form (Page 9)

To review your application, we ask for any documents, reports, references or letters of support that will help us understand your needs and support your application. You don’t have to wait to submit your application if you don’t have all the documents. You can submit what you have and we can follow up on the other documents later.

Below are some examples of helpful reports or documents you can share. You can add anything else that is relevant.

Required

Recent functional capacity or housing assessment conducted by an Allied Health Professional (e.g. OT report)

Recommended, if available

NDIS plan
Current support needs plan (e.g. person-centred plan, individual recovery plan)
Mental health assessment or review reports (e.g. clinical reviews/summaries, discharge summaries)
Risk assessment/management plans
Positive behaviour support plans or safety plans
Specialist assessment reports (e.g. neuropsychology, Sensory, Psychology)

Optional

Outcome measurements (e.g. WHO-DAS, HONOS, Basis 32)
Professional letters of support (e.g. GP, psychiatrist, support worker)
Rental, employment or other references
Any documents outlining forensic history, if applicable (e.g. forensic assessments, forensic mental health reports and community corrections orders).

Please click on the link below to attach your supporting documents. We can accept PDF, Microsoft Word and Excel documents, and photos.
If you have emails that you need to send, you can forward them to housingwithsupport@mindaustralia.org.au
If you need help to upload documents, please contact us and we can assist you.

Upload your documents here

Browse

Currently allows PDF, JPG, DOCX, XLSX, HEIC, and HEIF (photos taken by Apple iOS and Android devices)

We encourage you to review your answers to ensure they’re accurate before submitting this form.

Please contact us at housingwithsupport@mindaustralia.org.au if there are any questions you are unsure about or want to provide more information.

Please click on the button below to submit your application.

You will then receive an email to confirm your application has been submitted.

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