Money Mindset

Money Mindset
This application is the first step in the enrollment process for services. One Street At A Time operates in partnership with CJ Thomas Mental Health Agency to support service delivery and coordination of care.

All applicants are required to complete an intake and clinical assessment to determine eligibility and appropriate service placement. An application is not considered complete until the intake and assessment process has been fully conducted.

Services are delivered using standard, structured treatment modalities and include an integrated educational component. Participation is contingent upon clinical appropriateness, availability, and completion of all required enrollment steps.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
AnthemHumanaCaresourceAmeriHealthMolina
Acknowledgment Statement
By submitting this form, I acknowledge that I will be contacted by a member of the One Street At A Time team. I understand that I should be prepared to complete a 20–30 minute screening by phone at the time of contact.
Signature*
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