Applications and Forms

For more information on the application process, please call 440-352-8424 ext. 111.

Applications and Forms

*As of June 1, 2023 our waitlist is closed*

Application Instructions

  • All questions must be answered – we do not accept “N/A.”
  • Sign and date all required sections.
  • Certification of disability MUST be completed by a psychiatrist, psychologist, or mental health nurse practitioner.
  • An address must be listed on the application. All correspondence is currently done via mail.  If you do not have an address (i.e. you are homeless), list an address where you can receive mail. For information on mail services for the homeless, visit the USPS website.
  • All changes, such as to address or contact information, number of dependents, income, etc., must be submitted to our office in writing.