Transition Program @ CIDA Application Form
After completing this form, please send the final IEP, the recent psychological test report and Life Plan (if have one) to :
38-50 Bell BLVD. Suite A2
Bayside, NY 11361
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For more information, call (718)224-8197 ext. 3
Name of Parent (Guardian)
Name of Student
Age of Student
Telephone Number of Parent (Guardian)
Email Address of Parent (Guardian)
Year of high school graduation
High school diploma (NYS Regent Diploma)
NYS CDOS Commencement Credentia
Skills and Achievement Commencement Credential for Students with Severe Disabilities (IEP Only)
College (2 year or 4 year)
Do you have an active Self-Direction budget from OPWDD?
If yes - please provide the name of your broker, their telephone number, & email address.
Name of the fiscal intermediary (FI) and telephone number.
Currently enrolled programs/services (check all that applies)
Day Habitation Program
Supported Employment/Employment Training Program
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