Forms

Family Support/ Participant Directed Managed Services/Adult Service Coordination

BDS: Why Should Individuals with Developmental Disabilities Apply for Medicaid? (PDF)

Intake Application for Services (PDF)

Ingesta Solicitud de Servicios Espanol  (PDF)

Medicaid Information and Link (PDF)

2020 SINGLE Seniors Timesheet

2020 Payroll Calendar (PDF)

2020 SINGLE Timesheet

2020 SINGLE CARE VET Timesheet

Completing The Timesheet Instructions

Direct Deposit Authorization Agreement (PDF)
Mileage & Expense Reimbursement Form (PDF)

HOLIDAY SCHEDULE 2020 FIELD EMPLOYEES (PDF)  

Timesheet: Gateways for Seniors: Daily Task Definitions (PDF)

Campership Request Instructions FY20 (PDF)
Campership Request Application FY20  (PDF)
Consent To Bill (PDF)
Consent To Bill, Spanish (PDF)
COVID 19 Relief Fund Guidelines (PDF)
COVID 19 Relief Fund Guidelines Spanish (PDF)
COVID 19 Relief Fund Application (PDF)
COVID 19 Relief Fund Application Spanish (PDF)
Discretionary Funds Printable Application (PDF)
Discretionary Funds Printable Application, Spanish (PDF)
Environmental Modifications Pre-Survey Form (PDF)
Family Support Information (PDF)
Family Support Information, Spanish (PDF)
Respite Reimbursement Form (PDF)
Respitality Request(PDF)
Respitality Request, Spanish (PDF)

Guardianship Guide (PDF)
High School Transition Planning Checklist (PDF)
Medicaid Guide (PDF)
Medicaid Reference Sheet (PDF)
Social Security Guide (PDF)
Project Services Needs/Wait List Guide (PDF)

HIPAA Notice Of Privacy Practices (PDF)

HIPPA Notice Of Privacy Practice_Spanish (PDF)

NCI SURVEY LIVES AT HOME WITH FAMILY MEMBER

NCI SURVEY DOES NOT LIVE AT HOME WITH A FAMILY MEMBER

Universal Precautions Training (PDF)