Application for Enrollment

Application for Enrollment
Key Information
- Not a therapy program and not responding to physical disabilities; not a job placement program
- Portal for family interaction offered after enrollment
Eligibility
- Diagnosed or likely neuro diverse
- Health insurance
- Transportation
- Participate as a Citizen and be part of a community
Packages and Schedules
- Packages – 3 month, 6 month, 1 year
  - 8:30am-4pm
    
    Mon/Wed/Fri-$450/week
  - 8:30am-4pm
    
    Wed/Fri-$300/week
  - 8:30am-4pm
    
    Fri-$150/week
  - Afternoon Activity Pass
    
    -$25/Hr
  - Evening Activity Pass
    
    -$25
Citizen Personal Information
Date of Application

MonthDayYear
Date
Citizen Name ( Last , First, Middle Initial )
Address ( Street , City , State , Zip )
Primary Phone #
Email
SSN or Gov't ID:
Date of Birth:

MonthDayYear
Date
How did you learn about our program?
Previous Learning Experiences
What are some experiences you have had in the past that have influenced your interests? Example: I once had the opportunity to take pictures for an assignment and realized that I had a passion for photography.
Person-Centered Planning
How would you describe yourself?
What are good things people say about you?
What are some of your dreams? Where would you like to be in 5 years?
What is important to you? What do you want people to know about the things that are important to you?
What are some things that you have to have or do in order to feel happy?
Leisure/fun/activities:
Routines and rituals:
What do others need to know or do to support you at home, at work, and out in the community?
What helps you feel comfortable?
How do you calm yourself down when you are upset?
Is there anything else about you that you would like for us to know?
When can you start the On The Avenue program?
Policy Overview
Listed below is a short summary of each of our On The Avenue Policies if you choose to join the program. A handbook with full details of each policy will be given. You must review and sign off agreeing to abide by each policy while participating in the program.

Substance Free Enviroment

On The Avenue strives to provide a clean, healthy, and comfortable environment for all citizens, employees and guests. The using or being under the influence of tobacco, tobacco-like products (e.g. e cigarettes), drugs (other than previously cleared prescriptions), and alcohol is strictly prohibited on the Premises

Weapon Free

On The Avenue strives to provide a safe environment for all citizens, employees and guests. To help ensure a safe workplace, all citizens, employees and guests are prohibited from carrying or bringing any weapon on the premises. Weapon means any firearm, including but not limited to a pistol, revolver, shotgun, rifle, bb gun or any knife including switchblade knife, gravity knife, or any knife with a blade longer than 3 inches, or billy, blackjack, bludgeon, metal knuckles, bow and arrow, electric stunning

Dress Code

On The Avenue strives to provide a comfortable environment for all citizens, employees and visitors. Please avoid clothing with suggestive themes (sex, drugs, alcohol, violence etc, clothing that exposes your midriff, Pants that sag below waist, and any gang related clothing.

Safety

On The Avenue prepares all members of our community on the protocol and expectations in the event of an emergency affecting our people or physical facilities. Emergencies may occur from accidents on the property including, slips, falls, or injuries, weather conditions, and acts of violence.

Confidentiality

On The Avenue strives to provide a safe space for all citizens, employees and visitors to share their thoughts, feelings and opinions. Any confidential information, whether oral, written, or electronic, should be maintained in a manner that ensures its confidentiality.

Anti-Harassment

On The Avenue maintains an environment that is free from discrimination based on race, ethnicity, religion, sex, national origin, disability, age, genetic information or any other status for all citizens,
Meals

On The Avenue provides snacks to the citizens, employees and guests through our Avenue Bucks program. Citizens and employees will need to bring in their own lunches, as it will not be provided unless on a special occasion. Any time On The Avenue will be providing lunch, a notice will be sent out in advance.

Program fees, change, cancellation policies

On The Avenue program fees will be based on the schedule and contract length indicated upon entrance to the program. Once a schedule is indicated, attendance will not affect the agreed upon fee. Each citizen will be billed monthly. Change or cancellation in schedule/fees can only be made after your original contract length has been completed.

Transportation

On The Avenue provides all transportation for program related outings. Daily transportation to and from the program is the responsibility of the citizens and their families and is a requirement to take part in the program. On The Avenue will have an approved pick up list for each citizen. If a new person needs to be added to that list, the request must be made at least 30 minutes before pick up by one of the approved parties.

Weather/program cancellation

On The Avenue will occasionally have program cancellations due to in-service days, inclement weather or emergencies. When possible, On The Avenue will give 24 hours notice on impromptu cancellations. If a cancellation occurs during the day, and an early departure is necessary, we will get in touch with the Citizen's Emergency Contact
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Application for Enrollment

Key Information

Eligibility

Packages and Schedules

Citizen Personal Information

Previous Learning Experiences

Person-Centered Planning

Policy Overview