Independent Living Experience (ILE) Program

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Independent Living Experience (ILE) Program

RESPITE WAIVER FUNDING ACCEPTED!

We are already planning 2023 programming. Participation is limited – reserve your spot today using the online application below!

2023 ILE Brochure

ILE Online Application
Please complete all required fields or your application will not be processed. After you SUBMIT, please scroll down to verify that your form has been processed and a confirmation has been received.

Please complete all required fields or your application will not submit. After you SUBMIT, scroll down to verify that your form has been processed and a confirmation has been received.

Application Date*
MM slash DD slash YYYY

MA (Medical Assistance) Number

Participant Full Name*

Participant Date of Birth*
MM slash DD slash YYYY

Participant Gender*
Male
Female
Other
Participant Age (as of application date)*

Participant Address*
Participant Phone Number*
(###) ###-####
Participant Email*

Parent/Guardian Name(s)*

Parent/Guardian Address**
Parent/Guardian Phone*
(###) ###-####
Parent Email Address*

Select Any/All Participant Diagnoses*
Select All
Autism Spectrum Disorder
Intellectual Disability
Other (please list below)
Other Diagnosis, if applicable

Is the Participant Able to Navigate Safely in the Community with Minimal Support? If no, please explain.*
Does the Participant Exhibit Physical Aggression Toward Self and/or others? If yes, please explain.*
Does the Participant Have Sensory Needs? If yes, please explain.*
Is the Participant Able to Swim Independently Without Assistance? If no, please explain.*
Does the Participant Have a Criminal History? If yes, please explain.*
Is the Participant Currently Employed? If yes, where?*
Are There Any Medical Concerns That Would Limit Participation?*
Allergies
Asthma
Diabetes
Physical Limitations
Seizures
Sleep Apnea
Special Diet
Other
Check all that apply
Please Provide Additional Information if Any Box Above is Checked
Is the Participant Able to Self-Administer Medication and/or Medical Devices? If yes, how?*

Does the Participant Need Personal Care Assistance Care from Staff (toileting, bathing, feminine hygiene, dressing, etc.)? If yes, please explain.*

Does the Participant Have Case Management Services (OVR, supports coordination, BCM, family based services, etc.)? If yes, please list.*

Are There Specific Skills the Participant Would Like to Focus on at ILE?

Please List the Participant's Personal Goals for this Experience*

Please Provide Any Other Specific Information That Will Help ILE Staff Provide a Quality Experience*
Please Check Weeks of Availability*
Select All
June 11-16, 2023
June 18-23, 2023
June 25- June 30, 2023
July 30- August 4, 2023
August 6-11, 2023
Check all that apply
ILE Payment*
Personal payment
ESY/School district funding
Waiver funding
Glade Run Foundation scholarship
Achieva Trust grant
ARPA (American rescue Plan Act) Funds
Other
Check all that apply
School District Contact Information, if Selected Above

How Did You Hear About ILE?*

Glade Run’s Independent Living Experience offers an innovative opportunity for young adults with autism and/or intellectual disabilities to experience living away from home for six days. Young adults will gain confidence and understanding of their true abilities. During this six day stay, participants will be engaged in several different activities designed to increase social skills, promote adult readiness, build on employment skills, and encourage independence. Each day has a specific focus but also includes morning and evening activities, self-care time, group activity, meal preparation, and physical exercise.

Glade Run’s Independent Living Experience is designed for individuals diagnosed with autism and/or intellectual disability that are between the ages 18-35 years, have the ability to self-administer all medications, and those who have the ability to navigate the community with support at a 1:5 ratio. This is an unique opportunity for young adults and/or intellectual disabilities to experience independence!

How can applicants pay for I.L.E.?

– Waiver Funding (call your Supports Coordinator)

– Apply for a Scholarship (scholarship form available online)

– ESY (Extended School Year) (talk to your school district)

– Private Pay (payment plans available)

For waiver funding, your Supports Coordinators (SC) will need to know:

I.L.E. is a Respite Camp, 24 Hours, Eligible Day

Code: W7285

Glade Run Lutheran Services: 100754254

Needs Based Scholarship Application

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