Registration for Autism Waiver Prospective Provider Workshop
The MSDE invites you to join us to learn more about The Home and Community-Based Services Waiver for children with Autism Spectrum Disorder (ASD), also known as the Autism Waiver (AW). AW services are designed to provide long-term, person-centered therapeutic services and supports to eligible children and youth with ASD to enable home and community living as an alternative to institutional care.
Anyone wishing to become an AW provider must attend an Autism Waiver Prospective Provider Workshop. The person applying for a provider number must be the individual who attends the workshop. Attendance at the workshop is required before submission of the application or supporting documents.
Please register by completing this Google form; registration is required. Registrants will receive a reminder email with prior to the workshop. At the time of the workshop, please join the meeting using the link below. Thank you!
DATE: January 21, 2021
TIME: 9:00 AM – 12:30 PM
LINK TO JOIN:
meet.google.com/zxr-qxnm-wty
* Required
Email address
*
Your email
Please provide your full name
*
Your answer
Please provide agency name
*
Your answer
Please provide email address
*
Your answer
Please provide your phone number
*
Your answer
What AW services are you interested in providing? (Check all that apply)
Adult Life Planning (ALP)
Environmental Accessibility Adaptations (EAA)
Family Consultation (FC)
Intensive Individual Support Services (IISS)
Respite Care (RC)
Residential Habilitation (RH)
Therapeutic Integration/Intensive Therapeutic Integration (TI/ITI)
Please list any questions and topics you would like for us to cover during the workshop if time permits.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of State of Maryland.
Report Abuse
Forms