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Self Determination Initiative Application

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Downloadable Application Form



Application

About You

Eligibility Questions

I live in Jefferson county.

I am 18 years of age or older.

Application Questions

Have you applied and/or been approved for Self-Determination before?

Plan Supports and Cost

What items or supports are you requesting to reach your goals? Please note specifics if you have a program or provider in mind.

Please use the following fields

Name/DescriptionCost/UnitTotal Cost
Long Term Planning

Self-Determination is set up to provide short-term financial support as you’re working toward a goal. We ask that after a request is approved, you identify other resources available for any ongoing, long-term support. What plans do you have to sustain progress toward your goals when Self-Determination funding concludes?

Thank you for taking the time to tell us about your plans for the future. Please submit your completed application to a DDRC Resource Coordinator or Self-Advocacy Coordinator. You will receive a letter, typically with in 45 days, explaining what will and will not be paid for and the reason why.

Funding for this project is approved on an individual basis. The Self-Determination Allocation Committee will review and approve applications based on funds available. All funds must be spent by June 30th 2018.

Page Last Updated: 2017-09-27