Enrollment Form

1Getting Started

2Services Desired

3Person Served

4Diagnosis, Funding & Transport

5Team Information

6Personal Care & Support Needs

7Vocational Information

8Additional Information

9Upload Paperwork

Please note that several of our services have waiting lists. We’re working hard to bring as many individuals into our services as we can; current waitlists are moving slower than anticipated due to current staffing crisis.
Getting Started
During this application you will be asked for demographic and funding information about the individual with a disability, contact information for the individual’s team, support needs for the individual, and general questions about the individual’s social and employment history. At the end of the application you will be asked to upload documents related to the individual including (when applicable):
- Individual Abuse Prevention Plan (IAPP)
- Coordinated Service and Support Plan (CSSP) and Community Support Plan (CSP), or Individualized Education Program (IEP), or Individualized Support Plan (ISP)
- Proof of Disability: A psychological evaluation or diagnostic report (written and signed by a doctor/psychologist/psychiatrist) which states the person’s disabilities
- Positive Support/Behavior Plan
- Vocational Rehabilitation Services (VRS) Closure Paperwork
- Relevant Work/School/Residential Reports
This application cannot be saved, so please gather all available information before you begin. The application will take about 15-45 minutes to complete.

Questions? Contact referrals@opportunities.org or 952-930-4202

Guardian
Select Guardian
Name*
First Last
- This is the person inquiring
- Address is same as person served
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Case Manager
Select Case Manager
Name*
First Last
- This is the person inquiring
County/Organization
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Residential Provider
Is there a residential provider?
- Add residential provider
Provider Name*
Primary Staff Contact*
First Last
- This is the person inquiring
- Address is same as person served
Address*
Street Address Address Line 2 City State ZIP Code
Primary Staff Phone
Primary Staff Email
Other Team Member
Do you need to add another team member?
- Add another team member
Name*
First Last
- This is the person inquiring
Relationship*
Address*
Street Address Address Line 2 City State ZIP Code
Phone