Independent Living Allowance application

Young person details

Please enter the names as they appear on the birth certificate.

Given name:

Middle name (optional):

Last name:

Preferred name (optional):

Phone number:

Email address:

Confirm Email address:

Date of birth (dd/mm/yyyy)

Day

Month

Year

Do you need support in completing this application? (Optional)

Please write below the type of support you need, for example translation or disability support services.

I confirm that I have read and understand the privacy notice and consent to my information being used for application purposes.

I confirm that I have read the eligibility criteria and consent to a Department of Communities and Justice staff member contacting me to discuss my application.

Thank you for submitting the form.

You will receive an email containing the information you have submitted.

You may return to our website.

Your reference number: ILA

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