Non-Electronic Communication Aid Service – Application Form

Step 1 of 6 - Services required

Please complete this form to request professional development or communication aid resources from Scope’s Non-electronic Communication Aid Service. The NECAS team will confirm your request within 5 working days. To assist you in completing this form consider preparing the following before you start:
- Contact details for the person requiring support
- Details of the outcomes you are seeking
- NDIS plan details including dates, goals, funding category & budget (where applicable).
If you are uncertain about the type of communication aid for you, please include a consultation in your request. If you are uncertain about the content of the aid, or its design, select a communication aid packs option.

NECAS offers finite blocks of therapy to support communication systems. If you would like therapy your NECAS consultant can provide guidance and discuss therapy recommendations with you as a part of a communication aid pack. For information on the broader therapy services Scope offers you can refer to Scope’s specialised communication services.

Scope understands your privacy is important. All details entered into this form are private and confidential. For more information about how we protect your privacy and manage personal information please see our privacy policy.
Services required*
- Low tech communication aids and packs
- Customised professional support
Low tech communicaiton aids
Scope’s complex communication needs (CCN) consultants have the expertise and equipment to produce customised high-quality communication aids for adults and children. Our team will work with you to design and produce your customised aid.
We provide four core packs:
- Customisation support pack:
  Includes selection, design and content support (excludes PODD books). This is the default option for customised communication aids.
- My PODD book pack:
  Consultation on the range of books and support for customisation. Optional PODD book loan.
- Basic application:
  You provide the design specifications, including the words. NECAS will add in the symbols, design and manufacture the communication aid.
For further information on our communication aid packs refer to our product catalogue.
Select your communication aid service:
- Customisation support pack
- My PODD book pack
- Basic application
- PODD book loan. (If you would like assistance with your trial, please select “My PODD book pack” option)
Include a consultation to view the range of communication aid options:*
- Yes
- No
A consultation is useful to view the range of options available. You can use your NDIS Capacity Building funding to pay for this consultation.
Please purchase this directly from the Scope Shop.

Purchase Now

Your details
Please provide the contact details for the person making the request. This is the person who will be contacted by Scope to confirm the request.
Name*
First Last
Organisation
Position title
Email*
Phone*
Would you like Easy English (accessible written format) version of your documentation:*
- Yes
- No
Speech pathologist's details
Do you have the speech pathologist's details?*
- Yes
- No
Speech pathologist's name*
First Last
Speech pathologist's email*
Speech pathologist's phone*

Individual's details
Provide the details of the person requiring the communication aid.
Name*
First Last
Birth date*
DD slash MM slash YYYY
Gender
Address*
Street Address Address Line 2 City State Post Code Country
Email
Phone*
Primary disability/diagnosis*
Other disability/diagnosis
Is an interpreter required?
- Yes
- No
Details of Supports required
Please provide details of the individuals current communication skills and the services and outcomes you are seeking.
What supports or services are you seeking?*
What outcomes are you hoping to achieve?*
How does the person communicate?*
What are the person’s skills and abilities?*

Your obligations regarding the design and content
- For Basic Packs: All content and design specifications must be finalised at the time of submitting the application. We recommend that all stakeholders have been consulted prior to submitting your application.
- Drafts for all communication aid requests: A draft is provided once the communication aid is designed. Final accuracy is the responsibility of the customer, please ensure that you have thoroughly reviewed the draft before confirmation. Only minor edits can be requested at the draft review (e.g. change of spelling or image changes) and do not include substantial changes. Additional changes requested to the type of aid, the content or design, may incur additional fees.
- Communication aids typically take four weeks from receipt of application to collection/postage. Variances may occur, and timelines will be confirmed in consultation with the customer.
- Your communication aid can be updated with minor changes within one year of the original application (this will be at the discretion of the Non-electronic Communication Aid Service).
Consent
- You give Scope (Aust) Ltd permission to collect, use and/or share your information in relation to the services we provide to you. Scope requires you to provide us with your personal information to enable us to support you. Your personal information will be kept in accordance with the Privacy Act 1988 and Privacy and Data Protection Act 2014 (Privacy Laws). You can find Scope’s Privacy Policy on our website at https://www.scopeaust.org.au/privacy-policy/ or by asking a Scope staff member.
- You give consent for us to use your deidentifed information, and to invite you to participate in research, evaluation or education activities.
- I state that I am the applicant or an authorised representative for the person named in this application form. I have talked to the person about how, when and why information about them is to be collected and shared with others for the purposes of the service being provided by Scope.
- I am satisfied that the person understands the information on this form and give consent on behalf of the person for their information to be used on the terms set out in this form.
Intellectual Property
Any intellectual property which is created pursuant to this service being provided will be the property of Scope. Scope grants the customer or their representative a non-exclusive license to use the intellectual property where necessary to use the communication aids. This Agreement does not affect the ownership of any intellectual property rights in the material, works, items or systems created by or the property of a third party or the Contractor prior to the commencement of the Contracted Services or which is modified, adapted, developed or enhanced in the provision of the Services or created independently from the provision of the Services (“Pre-Existing Intellectual Property”). To the extent that any Pre-Existing Intellectual Property is incorporated into any materials (including Documents), the Contractor grants to Scope a non-exclusive, irrevocable, royalty free licence to use, reproduce and adapt the Contractor’s Pre-Existing Intellectual Property to the extent necessary to use material for the purpose for which it is provided.
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Consent*
I agree to the Terms & Conditions as stated above and Scope's privacy policy.
Comments
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Non-Electronic Communication Aid Service – Application Form

Step 1 of 6 - Services required

Please purchase this directly from the Scope Shop.

Your details

Speech pathologist's details

Service details

Payment details

NDIS plan details

Payer details

Individual's details

Details of Supports required

Draft and final product

Type of communciation aid

Communication aid customisations

List all that apply

Type of PODD book:

Consent

Intellectual Property

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Contact Us

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