Application for Services
Please complete this form to apply for DDA Services through Excel Support Services.
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Applicant's Name *
First and Last Name of the person seeking services.
Birth date *
Excel only serves adults who are 21 years of age and older
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Age *
Gender *
Permanent Mailing Address *
 House Number | Street Name, City , State | Zip Code
County *
Excel only provides services in the counties listed
Race/Ethnicity *
Applicant's discharge/graduation date if Transitioning Youth?
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/
DD
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What service(s) is the applicant applying for? *
Required
If unsure of the service, please provide any information to help us better understand the individual's circumstances and the support they need.
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