Group Support Availability

Please submit this form if you are interested in working any of the group support events for the upcoming month!

Providers who work with multiple clients will receive a rate increase for their services.

The following services can be provided at these events:

Respite with ONE client.
Respite with TWO clients
Respite with THREE clients

- or -

Habilitation with ONE client
Habilitation with TWO clients
Habilitation with THREE clients

Please Note Regarding Habilitation

Habilitation with multiple clients is permitted depending on each client's goal types, and if goals can be worked on in a group setting.

Provider First name*

Provider Last name*

Provider Email*

Your personal email address

GROUP SUPPORT OPPORTUNITIES

PLEASE SELECT THE GROUP SUPPORT OPPORTUNITIES YOUR ARE INTERESTED IN WORKING.*

SELECT ALL THAT APPLY

WE LOVE WEDNESDAYS | COMMUNITY OUTINGS

FUN FRIDAYS | ON CAMPUS SOCIAL EVENTS

SCHOOL BREAK GROUP SUPPORT | ON CAMPUS SUPPORT PROGRAM

NOT INTERESTED

PLEASE NOTE:

INTERESTED PROVIDERS WILL RECIEVE A MONTHLY EVENT SIGN UP FORM THAT WILL ALLOW PROVIDERS TO CHOOSE SPECIFIC EVENTS THEY ARE AVAILABLE FOR WITHIN EACH MONTH.

SUBMITTING YOUR INTEREST HERE DOES NOT REQUIRE YOU TO WORK EVERY EVENT TYPE YOU SELECTED ABOVE.

Are you currently providing services for an EE client?*

Yes

If yes, how many clients are you currently matched with?*

If no, please enter N/A.

Please select the services you are interested in providing :*

Choose all that apply.

*Please Note*

You DO NOT need to be currently matched with multiple clients to provide RSP2 or RSP3. We can help match you!

RSP1 - Respite with one client

RSP2 - Respite with two clients

RSP3 - Respite with three clients

HAH - Habilitation with one client

HAH2 - Habilitation with two clients

HAH3 - Habilitation with three clients

Are you interested in providing transportation to clients who need it?*

Yes

If you are currently matched with an EE client, and you are interested in bringing them to an event, please list their name below.

If you are not currently matched with an EE client, please enter N/A.

1. Client First Name*

1. Client Last Name*

If you are matched with multiple clients and would like to work with multiple clients at the event, please list their names below:

2. Client First Name

2. Client Last Name

3. Client First Name

3. Client Last Name

Do you have recommendations for venues or activities for future events? Please list them below!

We look forward to having you join in on the fun!