Forms

Family Support/ Participant Directed Managed Services/Adult Service Coordination

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

Application for Services (PDF)

Solicitud de Servicios Espanol  (PDF)

HIPAA Notice Of Privacy Practices (PDF)

Medicaid Information and Link (PDF)

Early Supports and Services

ESS Referral NICU Form 

ESS Referral Pediatric Form

2019 SINGLE Seniors Timesheet

2019 Payroll Calendar Db

2019 SINGLE Timesheet

2019 SINGLE CARE VET Timesheet

Completing The Timesheet Instructions

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

HOLIDAY SCHEDULE 2019 FIELD EMPLOYEES (PDF)  

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

2019 Campership Request Instructions (DOC)
2019 Campership Request Form (DOC)
Consent To Bill (PDF)
Consent To Bill, Spanish (PDF)
Discretionary Funds Online Application (online form)
Discretionary Funds Printable Application (PDF)
Discretionary Funds Printable Application, Spanish (PDF)
Environmental Modifications Pre-Survey Form (DOC)
Family Support Information (DOC)
Family Support Information, Spanish (PDF)
Respite Reimbursement Form (PDF)
Respite Reimbursement Form, Spanish (PDF)

Respitality Request(DOC)

Application Letter (PDF)
Guardianship Guide (PDF)
High School Transition Planning Checklist (PDF)
Medicaid Guide (PDF)
Medicaid Reference Sheet (PDF)
Social Security Guide (PDF)
Wait List Guide (PDF)

Gateways Community Services Privacy Policy (PDF)

Release of Information Form (PDF)

Universal Precautions Training (PDF)