Join the P1 Community and be Ready!
Waivers are work, but you don’t have to do it alone. We’re here to guide you through every step of the journey.To help families better understand and navigate their waivers, we’re creating a series of short, easy-to-follow videos with clear, actionable steps. If you are currently in Priority One, join our community of families to stay informed and prepared for when your waiver slot becomes available!Rest assured, your information will NOT be shared. Our goal is to help you access the services that work best for you and your family.
INFORMATION ON PERSON COMPLETING FORM
First Name
*
Last Name
*
E-mail Address
*
Which Best Describes You?
*
Please Select
Self-Advocate/Person with a disability
Parent/Family Member
INFORMATION ABOUT PERSON ON WAITLIST
Currently Priority One?
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Yes
No
I don't know - If you do not know, please contact your Community Services Board or Behavioral Health Authority to find out.
Other
Currently on the CCC+ Medicaid Waiver?
*
Yes
No
Age of the Person on the P1 Waitlist
*
0 - 2
3 - 6
7 - 14
15 - 21
22+
Current living arrangement of the person on the waitlist?
*
Lives with family
Lives in own place
Other
Name of the Person on Waitlist if you want to share
Is there another person we should send information to? If so please share their email.
INFORMATION ABOUT YOUR WANTS
Once you RECEIVE your Waiiver What Are you Looking for?
Which DD Waiver do you believe will meet your needs?
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Community Living
Family and Individual Supports
Building Independence
I'm not sure
ARE YOU INTERESTED IN ANY OF THESE SERVICES (not an inclusive list)
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Personal Care (Help with daily living tasks)
Companion (Care, socialization and support)
Respite (Services that give time off or time away for primary caregivers)
NONE OF THESE
NOT SURE
ARE YOU INTERESTED IN ANY OF THESE SERVICES (not an inclusive list)
*
Supported Employment (Help getting and keeping a job)
Community Engagement (Support to do things in your community that you enjoy)
Group Day Services (Attending a Program where other People with Disabilities are)
Peer Mentoring (Advice & Connection with another person who has similar life experiences living with a disability)
NONE OF THESE
NOT SURE
ARE YOU INTERESTED IN ANY OF THESE SERVICES (not an inclusive list)
*
Independent Living Supports (Living in your own home with a small amount of help)
Shared Living (Living with a roommate who helps with some reminders or support for daily tasks)
In Home (Living in your own home with help for tasks or skills needed -- can be a litte bit or a lot of support depending on what you need help with)
Sponsored Residential (Living in another person or families home and getting help from them for the things you need)
Group Home (Living in a House owned by a Provider Agency with 3 or more other people receiving services from that agency)
NONE OF THESE
NOT SURE
Submit
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