Application for Ages 3 and Above for Eligibility and Services

Application for Ages 3 and Above for Eligibility and Services

Informant Information

Applicant Contact Information

Informant Information

Applicant Contact Information

Employment Opportunities

Important Links

Employment Opportunities

Important Links

Regular Meeting of the Board and Ethics Council

Applicant's Name *

First

Middle

Last

Informant's Name *

First

Last

Relationship to applicant *

Caller's phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Applicant lives with: *

Phone *

Email *

Primary Developmental Disability Diagnoses (prior to age 22) *

Layout

Gender Identification

Preferred Pronouns

Layout (copy)

Current School or Providers

Current Services

Preferred Mode of Communication

Preferred Language

Additional Notes

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2021 Strategic Plan Progress Report

2023 Strategic Plan

DODD Provider Search Tool

DODD ICF Search Tool

DODD Residential Options Counseling

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March

28

Regular Meeting of the Board and Ethics Council
6:30 PM-7:30 PM
03/28/2023
Disregard end time; there is no set end time for this meeting