Applications and Forms

Arc Referral Application - Click here to download

Please complete the appropriate addendum in addition to the Arc referral application for the following services: Community Habilitation, LifePrep@Naz, Culinary Career Prep

The ROC Your Flight application is for those interested in registering for the next travel training session at the airport.

The My Time Provider application is for those individuals looking to become a My Time Providers

The Universal Family Cash Reimbursement application is for those that want to apply for family cash reimbursement.

The Universal Respite Verification form accompanies the Family cash reimbursement form for those that want to submit for respite.

Arc Health Services Referral Form


Have a question about eligibility?

Click here

Community Resources

Wondering what additional resources are available to you?

Click here