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Application Process

1. Call or email us to learn more about the CEP! Complete our interest form so we know how to contact you.

2. Come to one of our monthly Interest meetings. If you live out of town, we can arrange a day visit.

3. Schedule a student visit. These occur the fall before a student applies.

4. Complete the application

Let us know you are interested. We will contact you and send you a packet of information.

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Interest Form

Student Name:

*

Age:

  Date of Birth: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Highschool:

Graduation Year:

Current Program:

Current Job:

Diagnosis / Disability:

Contact Information

Contact Name:

*

Relationship to Student:

*

Phone:

*

Email:

*

Address:

City:

State:

Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory

Zip:

Year interested in applying for
(Fall 20_):

OMRDD Medicaid Waiver enrolled?

Yes No

Receiving SSI?

Yes No

Comments / Questions:

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