YDAS Map Your Future Expression of Interest Form

The Youth Disability Advocacy Service (YDAS) are back running a program called Map Your Future in 2019! It is for young Victorians with a disability aged between 16-25.

In Map Your Future, you will develop your self-advocacy skills, learn about the NDIS and about choice and control, you will also receive support with setting out goals for your future.

If you have any questions regarding the application, program, or accessibility needs, please contact Luke David at 0424 160 174 or ydasmyfadvisor@yacvic.org.au.

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* 1. What is your name?

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* 2. What is your age?

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* 3. Which City / Town do you live in?

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* 4. What is your email address?

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* 5. What is your preferred contact number?

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* 6. What is your preferred communication method? (Email, Phone, SMS)

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* 7. This is a list of common barriers and accessibility needs. Let us know if any of these apply to you or if you have an access need that isn't listed.

I use a mobility device like a wheelchair or walker and require accessible spaces.

I have low vision and require assistive devices.

I am impacted by different types of lighting.

I am Deaf, deaf, or hard of hearing and require assistive devices.

I am Deaf, deaf, or hard of hearing and require an interpreter.

I will be bringing a service animal.

I will be attending these workshops with my carer.

I have a limited use of hands or arms.

I have difficulties with speech and communication.

I have difficulties with reading comprehension.

I experience airborne reactions (allergies, chemicals, fragrances, etc.)

I will need to take breaks during the workshops.

My barriers or accessibility needs aren't listed.

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* 8. Have your parents/guardians agreed to you taking part in Map Your Future?

Yes

If no,
Would you like some support talking to them about it?

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* 9. Are you able to travel to the city of Melbourne if required?

Yes

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* 10. If travelling to Melbourne is too far for you, which location would you like the Map Your Future program to come to?

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* 11. Describe one thing that you would like to be able to do that you can't at the moment?

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* 12. What areas of your life would you like to be able to speak up about?

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* 13. What would you like to get out of the Map Your Future program?

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* 14. Do you have any allergies, intolerances, or dietary requirements?

Thanks for your expression of interest!
We'll be in contact with you as soon as possible.