COMPLETING THE DDA APPLICATION

A Step-by-Step Guide

DDA Application

DDA Application (Spanish)

Step by Step Guide

Step by Step Guide (w/ visuals)

Applying to DDA for Services

Pg. 1

Medical Assistance: only check yes if your child has/had Medicaid. Provide

a copy of the card if current.

Managed Care Organization (MCO): list the current insurance company

and physician for your child.

Pg. 2

Reports to support the disability: The Transition Specialist can help you gather the Special Education records from school. Reports from outside doctors (i.e. Kennedy Krieger) can also be helpful. Documentation is needed with the DDA application.
Do you require assistance?: The difference between continuous assistance when awake vs. 24 hours per day assistance; does your child require overnight & awake supervision (i.e. nursing, elopement concerns).

Pg. 3

How do you Communicate?: You can check off more than one box in this section if it applies.
Do you use any of these Services?: Check off any that the student may access in school or outside of the school day.
Personal Skills: When completing this section, think of your child on one of their most difficult days. What is the maximum level of support they need when completing each of these skills? DDA wants to know the highest level of support your child may need.

Pg. 4

Other Services: Board of Education (Local School System) is "Currently Served."

Pg. 5

If none of these programs/services are applicable, just leave the page blank.

Pg. 6

Professional/Agency Name: Write in your child’s school. Complete with the phone number and address for the school.
Information to be mailed to:
- - Regional Office Contact: DDA-Central Maryland Region*
  - Address: Attn: Eligibility and Access Unit, 1401 Severn St., Baltimore, MD 21230
Parent can complete the Signature, Printed Name, and Relationship to Applicant
Witness: Can be the signature of the Transition Specialist

* (Phone Number: 410-234-8246)

Pg. 7

Check Primary Caregiver. Parent can complete section with their personal information.

Pg. 8

Additional Contacts: This can be the other parent, siblings, grandparents, other immediate family, or a close family friend.
Statistical Information: This information is about the child.

Pg. 9

Child should sign for Signature of Applicant. For those unable to write, a simple mark or line with a pencil is sufficient.
Parent can sign as Authorized Representative.

Make a copy of the DDA application for your own file at home before sending to DDA.
E-mail the application & all relevant documentation to the Central Region Office (noting the date and time for your records)

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