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  • PAEP Fee-For-Service Application

    Thank you for your interest in PAEP’s Fee-for-Service programs and services! By completing this application, you are taking the first step toward accessing individualized employment, vocational training, and skill-building services through PAEP. Once submitted, a PAEP staff member will review the application and follow up with you to discuss next steps, service options, assessment, scheduling, and payment information.

  • Client Information:

  • Birthdate*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
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  • Receiving
  • Are you your own guardian?*
  • Type of guardianship:
  • Are you a citizen of the United States?*

  • Parent/Guardian Information:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Employment Preferences & Skills:

  • Transportation:

  • How do you plan to get to get to work?

  • Education:

  • Independent Living Skills & Self Care:

  • Communication & Behavior:

  • I respond when someone speaks to me
  • I make eye contact when talking to others
  • I use an appropriate tone of voice
  • I am comfortable starting a conversation
  • I engage in appropriate conversations
  • I use appropriate body language
  • I am aware of personal space
  • I swear/use profanity inappropriately
  • I lose my temper with others
  • I display aggressive behaviors
  • I use a cell phone at appropriate times
  • I am easily understood by others
  • I sometimes have trouble getting my message across to others
  • I use adaptive equipment to communicate
  • I do not engage in flirting, inappropriate touching or public displays of affection such as holding hands hugging or kissing
  • I work cooperatively with others
  • I talk about the same topics over and over again
  • I use an interpreter and /or sign language to communicate
  • I have acted aggressively in a school/work setting

  • Client/Parent/Guardian Consent:

  • 1. By signing this application, you authorize the release of the above information to Parents Alliance Employment Project (PAEP). All information provided will be kept confidential and will only be shared with relevant parties involved in the application and service process unless otherwise authorized by the applicant.

    2. Submission of this application and payment of applicable fees does not constitute completion of the PAEP intake process or enrollment into services. Final eligibility determination, service recommendations, and required PAEP intake paperwork will be completed during the scheduled intake appointment.

    3. Participation and acceptance into PAEP fee-for-service programs are contingent upon completion of the full application and participation in the interview process. Selection is made at the sole discretion of the Parents Alliance Employment Project team.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Comments:
  • Should be Empty: