Coordinating services that empower individuals living with disabilities in Connecticut

UCP’s Community Inclusion & Advocacy Program offers information, guidance and referral services to help individuals with disabilities in Connecticut remove barriers to independence.

If a barrier cannot be removed or if a need cannot be met by UCP, we provide information and refer individuals to our community partners who are able to meet their requests.

The Staff in UCP’s Inclusion & Advocacy Program will assist individuals with setting and reaching goals that lead to improved independence within the community of their choice.

OUR SERVICES INCLUDE:

Transportation management
Financial assistance (and management)
Medical/Social Security
Case management
Guidance in accessing one’s community
Basic needs assistance
Development of informed choice skills
Benefits application process assistance

The Inclusion & Advocacy Staff fields calls from individuals who need information and referrals for the following areas.

Contact Our Team

INFORMATION & REFERRAL

Medical
Assistance programs
Community resources
Transportation
Housing
Eviction prevention
Low-income and affordable housing
Heating Assistance
Home modification
Adaptive Equipment

This program is fully funded by foundations, donations and grants, including these partners who commit their support towards a healthy, thriving, sustainable community.

United Way of Southeastern CT
Community Foundation of Eastern Connecticut
Chelsea Groton Bank Foundation
Dominion Foundation
Electric Boat Employees
Gross Foundation
Atkins Memorial Trust
Community Foundation of Middlesex County
Dime Bank Foundation
M&T Bank Charitable Trust

UCP of Eastern CT is proud to be part of the United Way of Southeastern Connecticut’s Partner Program, which will help us expand our Disability Support Services to people with various disabilities, including Cerebral Palsy. Visitors to our site can use this free, 24-hour information and referral service funded by United Ways in Connecticut and the State of Connecticut: 211ct.org

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

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Employer
Contact Number
Supervisors Name/Title
- Paid
- Unpaid
Date Started
Date Ended

Job Duties

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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)
Phone
This field is for validation purposes and should be left unchanged.

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