Please fill out the form below to register your interest in an NDISP Platinum Plus smart home.
What is your name? *
If registering for a client, what is your company name?
What is your phone number? *
What is your e-mail address? *
What type of SDA are you eligible for? *
High Physical Support
Choose your preferred living arrangement. *
I don't want to share
I'm happy to share with 1 person
I'm happy to share with 2-3 people
Actual Address - if known type in notes below
Add additional notes here