Application form

You can apply for a needs assessment when you're ready. If you need help with your application, please call our Access team. We accept applicants from the greater Auckland region. For doctors, social workers and teachers, you can visit our professional referrals page for more information.

Main details
Name of the person with disability is required. Please type a value.
Birthdate is required.
Birthdate is not valid date.
It is not valid NHI number. e.g ABC 1234
This field is required.
Contact
This field is required.
This field is required.
It is not valid phone number.
It is not valid email address.
How should we get in touch?
This field is required..
Is language assistance needed?
What language?
This field is required..
This field is required..
Consent
You can attach any document showing your relationship with the disabled person. (Max 10mb)
{{vm.invalidMediaInfoFile.size / 1000000|number:1}}MB: Maximum file size is 10mb.
The type of field shoulde be image, xls, doc and pdf.
Because
This field is required.
This field is required.
Medical information
You can attach any letter from a GP, specialist, school or social worker that talks about the disability to fast track your application. (Max 10mb)
{{vm.invalidMediaInfoFile.size / 1000000|number:1}}MB: Maximum file size is 10mb.
The type of field shoulde be image, xls, doc and pdf.
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Thanks for sending your form.

We’ll review your application and get back to you within 48 business hours.