New Hussman Center Participants:
Complete all five required forms and return them to the Hussman Center by September 8th (scroll down for form links).
- If you attended Hussman Center programs and/or last filled out all five Hussman Center forms prior to 2017, you must fill out and submit all five required forms for Fall 2017 enrollment (compliance requires that we obtain up-to-date forms each year).
- If you attended Spring or Summer 2017 Hussman Programs and filled out all five required forms at that time, you need only complete and return the Participant Agreement Form for Fall 2017 enrollment (scroll down for form links).
Note: Each of the WORD forms listed below can be filled out on-screen by (1) downloading and saving the document to your hard-drive, then (2) opening the document back up and typing the requested information into the gray fields and checking boxes provided next to the items on the form. You will need a Word compatible program to complete this document on-screen.
If you do not want to or are unable to complete the forms on-screen, please download and print out the PDF version of the form. This version of the form must be printed and then completed by hand.
Complete a total of five forms below:
- Participant Information Form (complete ONE of the two Participant Information Forms):
Hussman Center Participant Information Form (Word) – This version allows you to type directly in the form and then print
Hussman Center Participant Information Form (PDF) – This version must be printed and then completed.
- Participant Agreement Form (PDF)
- IWB Health Care Protected Info Disclosure Form (PDF)
- IWB Request for Services (PDF)
- IWB Video Photo Release (PDF)
It is highly important that all forms are completed in full and returned to the Hussman Center prior to the start of programs. If forms have not been completed by the start of programs, the Hussman Center reserves the right to delay a participant’s admittance to their program until forms are submitted to the Hussman Center.
Please return ALL of the forms in one packet to us by one of the following methods:
Mail: Hussman Center for Adults with Autism, Institute for Well-Being, 8000 York Road, Towson, MD 21252-0001
Fax: 410-704-6303 (this number is for a fax machine in our business office)
In Person: By visiting the Institute for Well-Being Business Office, room 200, Institute for Well-Being, One Olympic Place, Towson, MD 21204, during regular business hours. The Business Office is open Monday to Thursday from 8:30 am – 5:00 pm and on Fridays from 8:30 am – 4:00 pm.