New Course Available!

Building Confidence Toward Independence!

Looking to gain more independence? Ready to become more confident in your skills and abilities?

Living with Assistance LLC is now providing our “Building Confidence Toward Independence” Course!

This course will be held via Zoom in small groups (no more than 12 per class) in order to provide a more individual and personalized focus for each participant.

Each week, we will cover a new topic that will help all participants to work toward building confidence in their independent living skills. This course includes an interactive workbook (sent via PDF), and participants should be able to read and write to an extent (assistance is welcome from family or support staff!). At the end of each class, we will play a review game and give a simple assignment for individual’s to put their new knowledge into action!

Upon completion of the course, you will receive a certificate that can be used for apartment, work, day program, and any other applications or resumes to show that you are continuing to work on building your independence!

COURSE REGISTRATION FORM

READY TO REGISTER?

COMPLETE THIS FORM TO REGISTER FOR THE “BUILDING CONFIDENCE TOWARD INDEPENDENCE COURSE!

Classes start January 2022!

Participant's Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

What town do you live in?

Guardian Name (if applicable)

If the individual attending the course is not their own guardian, please put the contact person's name here, and also list this person's email and phone number below.

First Name

Last Name

Contact Cell Phone Number

(###)

###

####

Contact Email

Tell us a bit about yourself!

This is where you can tell us about some of the challenges you face in becoming more independent, any diagnosis that effects your independence, or any other important information that we should know about you that you wish to share!

What do you hope to gain from this course?

Please select your preferred time for this Zoom course:

Please select one or more class options for this Zoom course, based on your availability as of January through March (10 weeks). We will be filling the classes first come first serve! This time slot is not guaranteed depending on the size of the group and we will reach out to you if your time slot is unavailable.

Tuesday 12pm-1pm

Thursday 3pm-4pm

Saturday 11am-12pm

Please select payment option:

Payment Agreement:

By typing your name below, you understand that we will be either billing DDD for this course or we will be charging your card for $349

Support Coordinator's Name, Email and Phone Number

If you would like to use your DDD Goods and Services Budget for this course, please provide us with you support coordinator's name and contact information so we can submit an invoice to them to begin processing this request.

Name on Card

If you are paying with a card, please enter the information below

First Name

Last Name

Credit/Debit Card Number

CVV/Security Code

(Usually 3 or 4 digits located on back of card)

Expiration Date

(If no specific day is determined in expiration date, please just enter "01" in the day place.)

MM

DD

YYYY

Zip Code for Card

This should be the 5 Digit Zip Code for the address attached to the card.