Sponsor Questionnaire
Impact Infusions LLC
Do you currently provide Sponsor Residential Services in your home?
Please Select
YES
NO
Have you ever provided Sponsor Residential Services in your home?
Please Select
YES
NO
How many years of Sponsor Residential Service do you have?
YEARS
Please list all persons living in your home and their relationship to you: Residents in the home 18+ are required to submit to a Criminal Background Check and a Central Registry Check Residents in the home 14+ are required to submit to a Central Registry search
These searches will be at your cost. Are you willing to comply with this protocol?
Valid Driver’s License:
Please Select
YES
NO
Registered vehicle:
Please Select
YES
NO
Valid Homeowners/Renters insurance:
Please Select
YES
NO
Valid Automobile insurance
Please Select
YES
NO
Do you have a bedroom available for the exclusive use of an individual?
Please Select
YES
NO
Please describe your experience working with ID/DD persons:
Please describe a difficult situation you have encountered servicing an ID/DD person while providing Sponsor Residential Services. If you have never provided sponsor services, please describe a difficult situation while working with an Individual under another service. Please describe how you handled the situation: (please use additional paper if needed)
What will you do to ensure your emotional wellbeing during stressful times, does not affect the client's emotional or mental health?
Submit
Should be Empty: