Template / Form

NCST developed this resource to provide background information on mobility for older adults with disabilities and profiles five individuals who have successfully made the transition from personal vehicle to public transportation. The packet includes a profile template and a model release form that service providers can use to create personal profiles of senior transit users in their own communities.

The Colorado Dept. of Health Care Policy & Financing (HCPF) developed a program that enables people with disabilities to manage their own attendant services. In the CDAS, people hire, train, supervise and fire their own attendants. They set their own attendant schedules and to a degree they determine what services the attendants provide. HCPF is not accepting applications for the CDAS at this time however, the forms provide an overview of the program and serve as templates for similar programs.

This series of worksheets provides examples of what the Michigan Nursing Facility Transition grant used in planning the transition from the nursing facility to the community. Review the worksheets for Daily Living, Employment Planning, Financial Planning, Health Planning, Housing Planning, Planning Template, Self-Determination, Social and Transportation Planning.

Michigan developed a six-part training on transition and diversion. Module 5 guides service providers through the transition periods and its follow-up. Handouts include transition planning guidelines and timelines, nursing facility transition services, and expenditure reports.

Federated Human Service Co-op exists to assist in the creation of Human Service Cooperatives (HSC) and to support those efforts in the most effective, efficient manner possible. They have developed two new resources to aid with the development of co-op groups. The Board of Directors Training Manual is designed for self-directed board of directors leading their own human service organization. The Policy and Procedures handbook is a template that can be modified to be program specific.

This site contains many policies and forms used in the Low Income Housing Tax Credit Program. Scroll down to DHHS Targeting Plans and Key Program Assistance to download documents: Program Procedures & Requirements, Support Coordinator Contact Information, Targeting Plan Template, Letter of Referral, Checklist for Initial Funding & Move-Ins, Direct Deposit, Authorization, Owner Agreement to Participate, Rent & Subsidy Calculation Worksheet, Payment Requisition, Termination Notice, IRS Form W-9.

Minnesota has shared two of their protocol surveys created as a follow-up to a more extensive, detailed gap analysis completed statewide in 2001. This update has been completed in 2003 and 2005, and will continue to be part of HCBS capacity assessment and HCBS capacity building. The analysis looked at the availability and demand of specific services, including long-term care supports, senior housing and long-term care beds. The 2001 Bulletin is also included for historical information.

This Care Notebook is an organizing tool for families who have children with special health care needs. Utah created the book to help families keep track of important health care information, list providers and community organizations contact information, prepare for appointments and file and share health history. Utah Family Voices shared this guide so that other resource centers may use this as a template when developing a similar tool.

Visit this clearinghouse, training and technical assistance center devoted to moving power and authority over resources directly to individuals with disabilities, families and allies. The website features publications, events, learning opportunities, resources and products including a new guidebook, Guaranteeing the Promise of Freedom. Designed for trainings, this guide addresses individual budget development, ways to re-thinking public dollars, an approach to quality and a budget template.

The state of Florida has offered a number of examples and samples of their Memorandum of Understanding (MOU) and a Memorandum of Agreement (MOA) between various state agencies. The roles and responsibilities of each party are set forth so that each party understands their functions in implementing the ADRC.