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Transition Program @ CIDA Application Form
After completing this form, please send the final IEP, the recent psychological test report and Life Plan (if have one) to :
CIDA
38-50 Bell BLVD. Suite A2
Bayside, NY 11361
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For more information, call (718)224-8197 ext. 3
Name of Parent (Guardian)
*
Your answer
Name of Student
*
Your answer
Address
*
Your answer
Age of Student
*
Your answer
Disability Category
*
Autism
Intellectual Disability
Multiple Disabilities
Other:
Telephone Number of Parent (Guardian)
*
Your answer
Email Address of Parent (Guardian)
*
Your answer
Year of high school graduation
*
Your answer
Highest education
*
High school diploma (NYS Regent Diploma)
NYS CDOS Commencement Credentia
Skills and Achievement Commencement Credential for Students with Severe Disabilities (IEP Only)
College (2 year or 4 year)
Other:
Do you have an active Self-Direction budget from OPWDD?
*
Yes
No
If yes - please provide the name of your broker, their telephone number, & email address.
Your answer
Name of the fiscal intermediary (FI) and telephone number.
Your answer
Currently enrolled programs/services (check all that applies)
Day Habitation Program
Supported Employment/Employment Training Program
College Program
ACCES-VR Services
None
Other:
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