Nevada State Funded - Sierra Regional Center (SRC) 2025

1. Click ‘Get Form’ to open the Nevada State Funded - Sierra Regional Center (SRC) form in our editor.
2. Begin by filling out the 'Participant and Common Law Employer Information' section. Enter the participant's name and ID, followed by the employer's name and ID.
3. Next, complete the 'Support Service Professional (Applicant) Information' section. Fill in your first name, middle name, last name, date of birth, gender, and social security number.
4. Indicate whether you share a residence with the participant and if you are related by blood or marriage. Provide details as necessary.
5. Fill in your physical address and mailing address if different. Include your contact numbers and preferred method of communication.
6. In the 'Enrollment Preference' section, select how you would like to continue the enrollment process—either online or via email/mail.
7. Complete all required background information fields on the next page to ensure compliance with program requirements.

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