Information Request Form
**Please note that Cedar Lake NO LONGER offers a pick up service for donated items and currently does not have a need clothing or furniture.
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are you interested in? (You may choose as many as you would like.)
Enrichment Center (Day Program/ADT)
Transportation (Jefferson, Oldham, Henry and Shelby Counties)
Daily Living Skills: Community Living Supports, Homemaker Services and Personal Assistance.
Parent & Guardian Support
Independent Living Apartment Options
Supported Living Options: Staffed Residences and Group Homes
Family Home Provider: Contracted Individuals who offer ongoing care for individuals with IDD from their home.
I am interested in becoming a Family Home Provider.
Specialized Care Lodge & Homes: Intermediate Care Facilities (ICF)
How to get on Waitlist for services
Give to Cedar Lake
Volunteer at Cedar Lake
Other
Tell Us More
**If you are not interested in applying for services, you can skip to the "Leave Us a Message" Box below.
How old is the individual interested in services?
Do you currently have a KY Medicaid waiver?
HCBS
Michelle P
SCL
Unsure
Do you have KY Medicaid?
Yes
No
Unsure
Leave Us A Message
Submit
Should be Empty: