Home
About US
Services
Family Support
Services
Resources
Calendar
CIL's in TN
Donate
Contact Us
Home
About US
Services
Family Support
Services
Resources
Calendar
CIL's in TN
Donate
Contact Us
T.A.R.P. Center for Independent Living
Consumer Goals
and Independent Living Plan
*
Indicates required field
Name
*
First
Last
Date Begun
*
County of Residence
*
Target Date
*
COVID Related?
*
Yes
No
My Goal is:
*
This will help me to:
*
Steps I will take in order to achieve my goal.
Step 1
*
Step 2
*
Step 3
*
I was directly involved in the development of this Independent Living Plan and agree to
participate in these services. I understand that I am not legally bound as a contract but I
affirm that I am committed to work toward achieving these goals and hope to achieve the
first goal by:
Goal Date
*
Approval or Waiver of Independent Living Plan
*
I accept the Independent Living Plan outlined above. I will work alone or with my ILS toward my goals.
I waive the right to establish an Independent Living Plan. I choose to develop my goals on my own and will seek advocacy when I feel it is needed.
Todays Date
*
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this form
*
I Accept
Any request for services or equipment is subject to approval and availability.
Upon approval you will be notified.
ILS Signature
*
Date
*
Submit