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2023-2024 Intake Form - Participant


Participant Information


If you are your own guardian, please enter your information.

(if this is your first year, enter 2022)

Please check all that apply:

Please give a short description:
CDA (Colorado Discover Ability) program volunteers and staff cannot administer medication or assist with the personal care of participants.

Name and share if any of the medications require special handling. (If they are not required please enter None.)
Thank you for participating in CDA programs! This process will be completed on an annual basis beginning October 1, 2020 and will be good until September 30, 2021. Colorado Discover Ability (CDA) is a non-profit organization and has limits on funding available for financial assistance. We strongly encourage participants to pay as much as they are able so that assistance will be available to others throughout the year. Our financial assistance is now provided on a sliding scale based on income.
There is additional information required to receive Financial Assistance: Please tell us what works best for you.

Case Worker Name & Contact