Please fill out completely and return it as soon as possible.
When we receive the application, we will send out the releases in order to gather the needed information to determine eligibility. In addition to the forms required by us, there is a checklist of additional documentation that will need to be gathered prior to receiving services.
If you have any of these documents, please submit them with this application. This will help expedite the process.
Once the needed information is received, we will contact you to review the participant’s needs and services and schedule a meeting to identify how we may address those needs. This may take up to 2 weeks depending on the information received.