Get Application For Eligibility Determination Childrens Ages 5-21 Closely - Mass

This guide offers a professional and supportive approach to completing the application for eligibility determination for children ages 5-21 with closely related developmental conditions in Massachusetts. By following these detailed steps, users can confidently fill out the form online and ensure all necessary information is accurately provided.

Follow the steps to complete the application accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the applicant information section, including the full name, date of birth, address, primary and secondary phone numbers, email address, and primary language. Ensure to indicate if interpreter services are needed.
3. In the diagnosis field, provide any relevant medical diagnosis information and specify the reason for applying.
4. Complete the authorized contact section by entering the details of the parent or guardian, including their full name, address, phone numbers, email, primary language, and relationship to the applicant.
5. Carefully answer the questions regarding prior evaluations. If there have been determinations of intellectual disability or closely related developmental conditions, ensure to attach the necessary documentation as instructed.
6. Gather and attach required documents, including proof of Massachusetts domicile, the applicant's birth certificate, social security card, and health insurance information.
7. If applicable, provide additional documentation such as recent early intervention plans, individual education plans (IEPs), psychological testing, and developmental assessments.
8. If someone other than the applicant or guardian is assisting with the application, provide their information and obtain the necessary permissions.
9. Sign the authorization for eligibility determination at the end of the application, ensuring that all signatures and dates are correctly filled in.
10. Review the completed application for accuracy and completeness; then save your changes, download, print, or share the form as needed.

Start completing your application for eligibility determination online today.