North Carolina Coalition to End Homelessness

PO Box 27692
Raleigh, NC 27611
Tel: 919-755-4393

SOAR Application for GreenvilleTraining

Thank you for your interest in SOAR Training for Casemanagers.

Fill out the following information to apply to participate in the training on October 21 & 22, 2008 in Greenville, NC.

Please note, completion of this application does NOT guarantee a slot in the training. NCCEH staff will contact you to discuss your application.

If approved, you will receive information on how to register and pay for the training.

Applicant Information

Name*
Title
Organization*
Email Address*
Phone (xxx-xxx-xxxx)*
City*

Implementation Information

2. Within three months after completion of SOAR training, I agree to complete at least one disability application with a client.*
4. Do you have access to or a relationship with a physician or clinical psychologist in your community who may be able to conduct needed evaluations? *
5. In order to continue to grow the SOAR project in North Carolina and provide reliable outcomes data for funders and users, I agree to provide NCCEH with data (protective filing date, length of application process and decision process, disability determination) for each disability applicant I assist. *
1. I am currently working with homeless adults who need assistance in applying for disability.*
2a. If no, please tell us why not:
3. Please describe your experience working with people with disabilities who have applied, are applying or are currently receiving SSI/SSDI , if any. *
I have discussed this application with my supervisor. My supervisor will support me by allowing:*
Supervisor's Name*
Supervisor's Email Address*

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