419-332-9296 szimmerman@scbdd.org

Intake and Eligibility

Request Form for Eligibility Determination

Please complete one of the Request Forms on the right if you are seeking services and supports through the Sandusky County Board of Developmental Disabilities.  The Request Form must be completed by the individual seeking services, their parent, or their legal guardian.

Select ‘Electronic Version’ if you wish to submit your Request Form electronically (requires Adobe Acrobat).  Be sure to download and save your Request Form on your computer before clicking to email your form to us.

Select ‘Print Version’ if you wish to print, fill out, and mail your Request Form to us.

Your Quick Start Guide to the Intake and Eligibility Process is available via the link on the right.

Contact Information:

Stacey Webb

Intake and Eligibility

Phone: 419-332-9296, ext. 164

Email: swebb@scbdd.org

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