The Grandest Drive - Participant Recommendation Form

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This form is to be completed by a provider who has worked with the associated individual who has expressed interest in applying for The Grandest Drive, a program hosted by the Branch Co Fair in Coldwater, MI.

This can be completed by the participants primary care provider, mental health/behavioral therapist, occupational/physical therapist, teacher, teacher’s aid, school psychologist, or case manager who has worked with the participant in the past year.

If you have any questions about providing the recommendation, please feel free to reach out to Dana Albright (608) 513-3285 or email thegrandestdrive@gmail.com

If you do not wish to complete an online form - there is a link to a form that can be completed and emailed directly to thegrandestdrive@gmail.com or mailed directly to the Branch Co Fair Office Attn: The Grandest Drive, 262 S Sprague St., Coldwater, MI 49036.

Name of the individual with special needs applying to the participate in The Grandest Drive (referred to ongoing as "participant") *

Name of the Recommending Provider *

Provider Relationship to the Participant (see list above of accepted provider types) *

Have you provided care to the participant in the past year (May 2022 - May 2023)? *

Yes - I confirm I have worked directly with the individual during this time.

No - I have not worked directly with the individual during this time and cannot provide a recommendation.

No - I have not worked directly with the individual during this time but have spoken with the Dana Albright regarding the recommendation.

Please review the details of the program on the Branch Co Fair website (www.branchfair.com/the-grandest-drive). *

Yes - I have reviewed the website and understand the program enough to provide a recommendation.

No - I have not reviewed the website (contact Dana or email for support)

Give my professional experience with the participant listed on this form and my understanding of The Grandest Drive program, I believe he/she/they would be a good fit for participation in this program.

Provider Signature

Please provide any additional information that you feel would be needed or helpful to provide a positive experience for the participant.

Submit

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