STRIVE Bayside Application

ELIGIBILITY CRITERIA:

  • Be a minimum of 18 years of age
  • Must meet eligibility guidelines established by the Department of Health and Human Services of the State of Maine and have the Community Supports Waiver (Section 21 or 29) or private pay at that rate
  • Provide STRIVE Bayside with a completed application packet
  • Applicant and parent/care provider must complete the application together.
  • Participate in an interview process, if PSL Services/STRIVE staff deems necessary.
  • Demonstrate an interest in possessing independent living skills, community connections, and pre-employment experiences that are necessary to attain substantial independence.
  • Have a proven ability to learn and participate in small group situations
  • Be willing to abide by all the rules and policies set for the by STRIVE Bayside – available upon request

 

QUESTIONS:

 

Contact: Veerle Pottie
vpottie@pslstrive.org

Application for participation: STRIVE Bayside

Address

Applicant Information:

Please complete the following section as thoroughly as possible. This information enables us to plan a safe and successful experience for the member

  Case Manager (if you have one):

Case Manager (if you have one)
Please check any that apply and add any additional under “other”
Please list the food, reaction, and treatment as applicable

Behavior: