Admission Requirements into CIS & H Inc's Program

We accept private and out of state children with developmental or Behaviour problems. The admission Requirements and FORMS to be completed and Faxed to us, by the Social Worker or the person making the referral are Listed bellow:

The following information should be included with the application for admission:

  1. Recent (last 12 months) Psychiatric Evaluation
  2. Recent (last 12 months) Psychological Evaluation including DSM II-R Diagnosis
  3. Recommendation from Therapist stating the program desired is the least restrictive environment for the applicant
  4. School records, including the last report card, IEP, if applicable
  5. Social History
  6. Court Report if any
  7. Progress report from prior placements
  8. Discharged summaries from prior placements
  9. Birth Certificate
  10. Social Security Card
  11. Immunization Record
  12. Consent Forms
  13. Prior Medical Exam information
  14. Medical Insurance information
  15. Any additional information that may be helpful in determining the appropriateness of the applicant for the program
  16. Up to date Form 818.
  17. Social Worker's Phone Number, Cell Phone Number, Fax Number and Email Address

Please Note:
According to Therapeutic Group Home regulations, A statement based on clinical evaluation by a licensed or certified mental health professional stating that the applicant otherwise meets applicable admission criteria, should be included for CIS&H Inc. referrals:

Some Required Docouments:

(1) Admission Documents Checklist (2) Child's Contacts while in Program (3) CISH Parent Handbook
(4) Consent for Treatment Form (5) Fire Safety Assessment Form (6) Intake Assessment Form
(7) Nonresident Student Enrollment