Get Project Access Bapplicationb Form - Cp Rochester

This guide provides clear, comprehensive instructions on how to effectively complete the Project Access Application Form for CP Rochester. By following these steps, users will ensure that their application is completed accurately and efficiently.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the Project Access Application Form and open it in your preferred editor.
2. Begin by filling out the application information section. Input your full name, date of birth, address, daytime phone number, city, state (New York), and zip code. Ensure accuracy as this information is crucial for processing your application.
3. Next, provide your social security number and evening phone number. Additionally, fill in your Medicaid number if applicable.
4. In the disability section, check all relevant boxes that apply to your situation. This includes various mobility and sensory impairments, as well as any other identified needs.
5. Move on to the family member/emergency contact information section. Here, enter the name, relationship, and phone number of your family member or emergency contact, along with their address and city.
6. In the service coordinator/advocate section, provide the name, phone number, and agency of your designated service coordinator or advocate.
7. You must acknowledge the understanding of information sharing by signing and dating the form at the designated space. This signature indicates your consent to share necessary details with the transportation agency and local OPWDD.
8. Finally, once you have reviewed all entered information for accuracy, complete any remaining fields. You can then save your changes, download the form, print it, or share it as required to complete your submission.

Ready to complete your application? Start filling out the Project Access Application Form online today.