Program Forms

Spring 2024 Forms are due by 4:00pm on Monday, February 12^th

The following forms must be completed once a year. Not sure if your forms are due? Contact our office at 410-704-4486.

The forms below are completed online securely using Adobe Docusign:

Health Care Protected Information Disclosure Form

Request for Service

Participant Agreement Form

Participant Information Form

It is 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, the Hussman Center reserves the right to delay a participant’s admittance to their program until forms are submitted.

The forms below are completed online securely using Adobe Docusign:

If you’re a NEW CAPS participant or have not participated in more than 1 calendar year, your Forms for the Spring semester are due Monday, January 22^nd

All Returning participant CAPS Forms for Spring 2024 are due January 22^nd, 2024

All CAPS Payments will be due Monday, January 29^th, 2024

Health Care Protected Information Disclosure Form

Request for Service

CAPS Returning Participant Confirmation Form

CAPS Participant Agreement Form

The form below is completed online securely using Adobe Docusign:

Lisa Higgins Applications are accepted for the Fall and Spring semesters.

The Lisa Higgins Application’s for the Spring CAPS Program are due Friday, January 25^th. Lisa Higgins applications for Fall Group programs are due by February 8^th, 2024. Responses to applications are due February 9^th.

Lisa Higgins Application