CLASP Annual Membership

CLASP Application

$25 ANNUAL FEE

Question Title

* 1. Type(s) of Service(S) Provided:

Care Homes and other Licensed Group Living

Supported Living or Independent Living Services

Respite

Day Program

Supported Employment

Other Employment Development Services

Clinical, Consultation, Legal, etc.

Children's Behavioral Health

Adult Behavioral Health

Administrative (FMS, Payee, Independent Facilitator, etc.)

Early Intervention Services

Family Foster Agency/Homes

Crisis Services

Dual Diagnosed Services

Other (please specify)

Question Title

* 2. Type(s) of Service(S) Provided:

Care Homes and other Licensed Group Living

Supported Living or Independent Living Services

Respite

Day Program

Supported Employment

Other Employment Development Services

Clinical, Consultation, Legal, etc.

Children's Behavioral Health

Adult Behavioral Health

Administrative (FMS, Payee, Independent Facilitator, etc.)

Early Intervention Services

Family Foster Agency/Homes

Crisis Services

Dual Diagnosed Services

Other (please specify)

Question Title

* 3. What Training Opportunities Would You Like CLASP to Provide or Arrange?

Health Related

Title 17 and Title 22 Regulatory Compliance

Management and Organizational Leadership

How to Engage Your Legislators and Policymakers

Employment Development

Courts and other Legal Issues

Behavioral Supports

Grant Writing

Direct Support Professionals: Ethics and Core Competencies

Person Centered Planning and Thinking

Medication

Compliance with the HCBS New Rules

LGBTQ Issues

Current State and Federal Budget and Other Legislation

Business and Marketing

Crisis Management

Other (please specify)

Question Title

* 4. Membership Type

New Member

Renewal

Question Title

* 5. Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 6. Please Send Me or My Agency an Invoice

Yes

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