Standard Disclosure and Acknowledgement Form, 2026

1. Click ‘Get Form’ to open the Standard Disclosure and Acknowledgement Form in our editor.
2. Begin by entering the date on which the form is completed. This is crucial for record-keeping.
3. Fill in the Advance Payment and Security Deposit amounts as required. Ensure you refer to the relevant policies for guidance.
4. Complete the section detailing Other Services Costs. Use the provided table to indicate any additional services selected.
5. For Choices for Independence Waiver Participants, provide necessary income documentation details as specified.
6. Indicate your Personal Needs Allowance and ensure all meal preferences are noted accurately.
7. Review the Services section carefully, checking off any shared or private services that apply to your care needs.
8. Finally, ensure all signatures are obtained at the bottom of the form from both the prospective resident and facility staff.

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