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Family-Selected Private Respite Providers and the Adaptive Equipment Application

You have until 11:59 p.m. on December 9 to complete the application. PP/AE funds application must be received no later than the due date to receive a PP/AW Quarterly Allocation. Please keep your confirmation email. If you do not receive a confirmation email, or have any other questions or concerns you wish to share, please contact us at (614)844-5847.

Individual's Name

Parent/Guardian Name

Address

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