Initial Member Application

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The following application is the first step in our process for new participants at The Center. Completion of this form allows us to get to know future participants better and does not guarantee acceptance. If you have any questions regarding the application process please feel free to email our team at info@newtransitionscenter.org.

*All fields are required to be completed in order to submit, please review the questions prior to beginning the application.

Email *

Full Name of Applicant *

Birth Year of Applicant (ex. 1981) *

Full Name of Person Completing Application *

Relationship to Applicant *

Applicant Address *

Best phone number to contact applicant or caregiver: *

Does the applicant require adaptive equipment required for communication? *

ex: Tobii, iPad or Transcription ePad

What type of activities does the applicant engage in outside of the home and how frequently? *

What are some goals you would like to see the applicant work on over the next year? *

Does the applicant have any behavioral concerns? If yes, please give a short description including any plans in place to manage the behavior. *

Does the applicant require assistance when using the restroom? If yes, please describe the level of need. *

How did you hear about The New Transitions Center?

Would you like to be considered for a membership scholarship? *

Yes

Not at this time

Send me a copy of my responses.

Submit

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