Partners and Pals 2019 Exception to The Rule Request for One-on-One service

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The Arc of Tri-Cities offers limited one on one service. To access this service, a family must complete the Partners n Pals application and Exception to the Rule Form, available online or at The Arc. The Arc, after reviewing the request, will contact you to discuss the request.

The Arc of Tri-Cities has gone to the standard of 1 on 2 and call it "Intense Supervision" if you feel that this will not meet your child’s needs due to safety and or behavior, please complete the following form.

Email *

Parent Name *

Child's Name *

Age of Child *

Have you turned in your Partners N Pals application *

Yes

Is your child Dial-A-Ride eligible? *

Yes

What is the safety or behavior that you feel your child will require One-on-One *

What is the funding source? *

Developmental Disabilities Administration

School District

Private Pay

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of The Arc of Tri-Cities. Report Abuse

Forms