Healthcare assessments, education and assistance for people with developmental disabilities in Connecticut.

Helping people on waiver programs coordinate their healthcare for optimal health and well-being.

Our program provides healthcare assessments for people with disabilities in CT, along with educational services and healthcare coordination. Provided by our registered nurse, UCP offers these services to individuals on Waiver Programs in CT, who have identified health risks, who, as a result of their intellectual disability, have a limited ability to identify changes in their health status or to manage their complex medical conditions.

The people we help have medical needs that require more healthcare coordination than what is available through primary healthcare providers. Our coordination services ensure their health, safety and well-being.

Our team facilitates clear communication between primary care physicians, medical specialists and behavioral health practitioners. We also facilitate communicate with family members, direct support staff and the individual to allow for follow through on medical recommendations. Our goal is to have the people we serve live in the least restrictive setting possible — with the greatest level of health, safety and independence.

Contact Our Team

Personal Data
Name*
First Middle Last
Present Address*
Street Address Address Line 2 City State ZIP Code
Cellular Phone Number
E-Mail Address*
Date of Birth*
MM slash DD slash YYYY
Gender
Are you a student?
- I am a student
School Currently Attending*
Current DDS Provider
Name Type of Service

Please list name and type of service (GSE, Day, ISE, IDV etc.)
Referral Contact Information
Referral Contact Name
First Middle Last
Referral Contact Email
Referral Contact Address
Street Address Address Line 2 City State ZIP Code
Referral Contact Cellular Phone Number
Referral Contact Signature
Referral Contact Signed Date
MM slash DD slash YYYY
Referral Contact Name
First Middle Last
Referral Contact Email
Referral Contact Address
Street Address Address Line 2 City State ZIP Code
Referral Contact Cellular Phone Number
Referral Contact Signature
Intern Candidate Information
1. Universal Release: I authorize the release of educational and employment records concerning the intern candidate from his or her school, DDS program or Employer to UCP of Eastern CT and Project SEARCH Partners.
2. Equal Opportunity: Project SEARCH placement will be made without regard to race, color, age, sex, national origin, cultural or economic background, housing circumstances is entitled to equal opportunity for educational development.
Candidate Signature*
Signed Date*
MM slash DD slash YYYY
Future Employment Preferences and Background
What is your career of interest?*
How do you want to be employed in the community upon the completion of Project SEARCH?*
- Full-time
- Part-time
List jobs you do or have done in the school or in the community (paid or volunteer)
Employer
Contact Number
Supervisors Name/Title
- Paid
- Unpaid
Date Started
Date Ended
Job Duties
Employer
Contact Number
Supervisors Name/Title
- Paid
- Unpaid
Date Started
Date Ended
Job Duties
List other jobs you do or have done in the school or in the community (paid or volunteer)
Candidate Response Question
Why do you want to participate in Project SEARCH?*
Complete in your own words and/or person assisting will write the responses in the candidate's own words.
References:
Please provide 3 references.
Required*
Name Relationship Phone Number Email Address
Assistance
The person assisting the candidate to complete this application is:
Name*
First Last
Title*
Organization*
Phone Nuimber*
Email*
Signature*
Date
MM slash DD slash YYYY
School Personnel Only
- Completed Application Packet (Student/Family completes and submits)
- High School Transcript (Local School/EUPISD will submit on behalf of intern)
- Attendance Record (Local School/EUPISD will submit on behalf of intern)
- Current IEP (Local School/EUPISD will submit on behalf of intern)
- Most Recent Evaluation Team Report (Local School/EUPISD will submit on behalf of intern)
Email
This field is for validation purposes and should be left unchanged.

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