Provider Suggestions for Ads

Title*

Category*

Location*

Phone*

Cell Phone Number (if Any)

E-mail (if Any)

Website address: (if Any)

How many openings (if any):

Male, Female or Both:

Age range:

Disability types taken in placement:

(Intellectual Disability (DD), Mental Health(MI), Autism, Chronic Illness, Hearing Loss and Deafness, Intellectual Disability (DD) Learning Disability, Memory Loss, Physical Disability (Wheelchair accessible), Vision Loss, Behavioral)

Physical Accommodations Available

Wheelchair Hoyer, Lift Ramp, Hospital Bed, Stair Lift, Bathroom Hand Rails

Funding Types Accepted:

DD Waiver, CAC, CADI Waiver, TBI, Elderly Waiver, Private Pay, Medical Assistance

Supported Employment details:

Staff Ratio/Staff Qualification:

How many people currently in Home or that your service:

How many people you can have in total:

Activities provided by Facility/company:

Activities near the area (shopping malls, activity centers):

PHOTOS: Exterior of facility, photos of people/staff (make sure to get a release)

Qualifications of Provider. Education, experience, training, time running business