We’re excited to join you on your self-direction journey!

To allow us to best serve you, please provide the following information:

    First name (required)

    Last name (required)

    Your Email (required)

    Your Phone Number (required)

    Which Minnesota County does the Participant reside in?

    Please choose one:

    Do you need an interpreter?

    Please list your primary or preferred language

    Please tell us how you would like our Intake Specialists to contact you:

    Please provide a few options of dates and times that match your availability: