Apply for Waiver Services

We look forward to serving you in ways that are meaningful and tailored to your needs and goals. Our master's-level Behavior Consultants and internally trained Life Skills Technicians are ready to help you build skills in the community, in our on-site training spaces, and in your home.

Have questions?

Email WaiverServices@PartnersinAutism.com and our Director of Life Skills and Career Development will contact you.

Our PAC Services

The Partners Difference

Our Behavior Consultation

Client's First name

Client's Last name

Full Name of Guardian (if applicable)

Upload guardianship documentation (if applicable).

Phone

Preferred time and method of communication

Ex. morning/afternoon/evening, email/phone

Date of Birth

Month

Day

Year

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Have you ever received services from Partners in Autism or participated in our social groups? Please list services/groups.

Which Waiver Services are you interested in? (Select all that apply)

PAC Services

Behavior Consultation

Life and Career Skills Courses

Briefly describe the skills you want to build.

This will help us get to know you and the goals you have for yourself. We will dive much deeper in-person during intake.

Briefly describe your desired schedule and number of funded hours available (if known)

If interested in PAC, are you or another family member/family friend interested in being trained as a Family Support Technician? This would enable you to be compensated for care you already provide.

Yes

Possibly

Does not apply

What funding source do you plan to use? (Select all that apply.)

IN Family Supports Waiver

IN Community Integration and Habilitation Waiver

ESA (Indiana Educational Scholarship Account) *education related activities only

Private Pay

Other

Upload current funding source documentation. Multiple files can be uploaded.

Case Manager name and contact information (if applicable)

I authorize Partners in Autism to request and receive information from my case manager, funding sources, etc. pertaining to my services at Partners in Autism. I understand that I am permitting the release of Protected Health Information (PHI) and that Partners in Autism will protect this information in accordance with HIPAA privacy rules.

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