PY19 Virtual Group Day Services for Adults with Disabilities Program

PY19 Virtual Group Day Services for Adults with Disabilities Program

COVID-19 Response: Combatting social isolation, depression, and anxiety for people with disabilities and their caregivers.
Service: Virtual Group Day Services for Adults with Disabilities
In response to COVID-19, The Arts and Education group day programs seek to combat social isolation, depression, and anxiety for people with intellectual and developmental disabilities (I/DD) through virtual curriculum, community learning environments, and mental health support. The virtual program, launched one-week after shelter-in-place guidelines went into effect on March 13, 2020, is offered at no cost to the participant. There are no fees for the service as it is in response to the effects of COVID-19.

Service: Respite for Caregivers
While participants are engaged in virtual learning environments, the caregivers in the household are given respite, a temporary rest/break from direct care. Direct care which has become even more taxing through the global effects of COVID-19. In response to COVID-19, this program targets support and care for the caregiver.
PY19 Virtual Group Day Services for Adults with Disabilities Program

COVID-19 Response: Combatting Social Isolation, Depression and anxiety for people with disabilities and their caregiver.
Name of Head of Household

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address Documentation of Travis County CDBG Service Area Residency

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US Citizen or Legal Resident
Email
example@example.com
Phone Number

Area CodePhone Number
Are you or someone in your family experiencing a Intellectual and/or Developmental Disability?
What type of disability
Documentation of Disability

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Ethnicity of Household
Race of Household
Rural Area Status
Limited English Proficiency Status
Total Number of Individuals in the household
Total household income
Total Number of CAREGIVERS in the household
Caregiver 1 Name

First NameLast Name
Caregiver 1 Gender
Caregiver 1 Ethnicity
Caregiver 1 Race
Caregiver 1 Age
Caregiver 2 Name

First NameLast Name
Caregiver 2 Gender
Caregiver 2 Ethnicity
Caregiver 2 Race
Caregiver 2 Age
Caregiver 3 Name

First NameLast Name
Caregiver 3 Gender
Caregiver 3 Ethnicity
Caregiver 3 Race
Caregiver 3 Age
Caregiver 4 Name

First NameLast Name
Caregiver 4 Gender
Caregiver 4 Ethnicity
Caregiver 4 Race
Caregiver 4 Age
Below is information for the individual attenting the program
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Students Gender
Students Ethnicity
Students Race
Students Age
Request Days of the week to attend
In case of Emergency Contact

First NameLast Name
In case of Emergency Contact

Area CodePhone Number
Should be Empty:

PY19 Virtual Group Day Services for Adults with Disabilities Program

PY19 Virtual Group Day Services for Adults with Disabilities Program

Below is information for the individual attenting the program