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Leader Referral Application Form

"Leader" is the term used to describe a person with a disability who uses a personal assistant. The Leader directs the work of his or her Personal Assistant and exercises maximum control over how the service is organised, including recruiting, training and supervising the P.A. A Leader must be between 18 and 65 years old with a significant physical or sensory disability.

1. Click on the link below to view the referral application form online.
2. Save to your PC as a local file.
3. Fill in the form and save when completed.
4. Print out completed form and post to LAPWD.
5. Or email back to lapwd02@eircom.net attaching your completed form.

Application Form (MS Word - 109KB)