KCDD's AAA + IDD Informed Partnership Award

1. Application General Information

KCDD = Kansas Council on Developmental Disabilities

IDD = Individuals with Intellectual or Developmental Disabilities
Self-Advocate = An individual with Intellectual or Developmental Disability
AAA= Area Agency on Aging

Question Title

* 1. Applicant Agency/Organization's Legal Name

Organizational Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

County

Email Address

Phone Number

Question Title

* 2. Authorizing Official (Full Name)

Question Title

* 3. Federal Employer ID Number (FEIN)

Question Title

* 4. What kind of services does your organization provide?

Information and Assistance

In-Home Services and Respite

Nutrition Programs

Caregiver Support

Case Management & Assessment

Transportation

Legal Services + Future Planning

Health Promotion

Meals on Wheels

Other (please specify)

Question Title

* 5. What areas do you serve in Kansas?

Question Title

* 6. Have you or do you currently serve individuals with IDD?

Yes

No

Question Title

* 7. If you have served aging individuals with IDD, what programs did you offer?

Question Title

* 8. Do you currently collaborate with your local Community Developmental Disability Organization? If yes, how have you worked together?

No

If yes, please described: