Get Wi Inclusa Adult Family Home (afh) Program Statement 2020-2025

Completing the WI Inclusa Adult Family Home Program Statement is an essential step for applicants seeking certification. This guide provides clear instructions to help users fill out the form online efficiently and accurately.

Follow the steps to successfully complete the program statement.

1. Press the ‘Get Form’ button to obtain the form and open it in your online editor.
2. Begin by filling in the name and address of your Adult Family Home, including city, state, and zip code.
3. Indicate the county your Adult Family Home is located in.
4. Identify the target group(s) you will serve by checking all applicable boxes, including developmental disability, physical disability, elderly, mental health, or other.
5. Specify the number and gender of individuals. Select the appropriate box for one or two persons, indicate if it is a shared room, and provide preferences regarding gender.
6. If applicable, indicate your intent to provide temporary respite care, including details about the number of adults, the description of the bedroom space, and the presence of additional staff.
7. Select the appropriate accessibility options for your home—ambulatory, semi-ambulatory, or wheelchair accessible.
8. Describe your home by selecting the type (two story, one story, mobile home, or other), the location (town/city, rural area, or farm), and indicate smoking policies and pet presence.
9. List resources near your home, such as churches, restaurants, public transport, grocery stores, and more.
10. Provide a brief description of your Adult Family Home that you would share with prospective residents.
11. Outline activities you will use to help individuals integrate into community life.
12. Indicate whether you have a wheelchair accessible vehicle.
13. Describe the services and skills your home offers, along with any additional information that may assist prospective residents.
14. List other household members and their relationship with the sponsor.
15. Secure the applicant’s signature(s) and date the form.
16. Complete the document and return it via email, fax, or postal mail as outlined in the instructions.

Complete your WI Inclusa Adult Family Home Program Statement online today!