IMPORTANT: I affirm that I have completed the Consumer-Directed Care Plus New Participant Training program. I also understand and acknowledge that if goods and/or services are purchased that are not approved in my Consumer-Directed Care Plus (CDC+) monthly budget and Purchasing Plan that I will be PERSONALLY LIABLE for payment of the cost of those good and/or services.

***Disclaimer: All information needs to be completed in order to proceed to take the Readiness Review and receive a certificate of Completion***

Please fill in the following information:
(Name, email, address, phone number, and consumer name are required)

First Name:
Last Name:
Home Address:
Email:
Phone:
Area:
Consumer Name:
Agency:
Which Training did you take?:
- Self-Train
- Face to Face
- Via Lync Webinar