Add Service Provider - California Self Determination Is Me

Your Details

Name *

Enter your name.

Email *

Enter your email address.

Enter Listing Details

Name:

Please include your first and last name

Company name: *

if different from your name-please include if you are an individual Service Provider working with a Service Provider Agency. If your Name is your "company name" please also place it here.

Email address:

Phone Number:

Professional Address: *

please consider getting a PO Box if you work from your home

City *

Click on above field and type to filter list or add a new city.

Zip/Post Code

Please enter listing Zip/Post Code

Click on "Set Address on Map" and then you can also drag map marker to locate the correct address

Address Latitude *

Please enter latitude for google map perfection. eg. : 39.955823048131286

Address Longitude *

Please enter longitude for google map perfection. eg. : -75.14408111572266

Select Map View

Please select listing map view to use

Web Address:

Facebook:

Instagram

X ( Twitter )

LinkedIn:

Which categories best describes the Service(s) you provide? *

Select all appropriate categories:

Default Category *

The default category can affect the listing URL and map marker.

About You: *

Please note the information you submit on this form will be posted in our directory as you type it. We will not edit except for obvious spelling errors. Use this space to tell your potential Self-Determination Program Participants about you, your professional experiences and why you do what you do.

If you are located OUTSIDE of California, do you have a California Business License?

Yes

Not Applicable N/A-not listing a “paid” service

What Services Do you Provide?

Tags are short keywords, with no space within.(eg: tag1, tag2, tag3).

Are you already serving Self-Determination Program Participants? *

Yes

Are you onboarded with any Financial Management Service Agencies (FMS)? *

Yes

Not Applicable N/A-not listing a “paid” service

Please list which FMSs you are with:

Are you Vendored with a Regional Center? This is NOT required to serve Self-Determination Program participants.

Yes

Not Applicable N/A-not listing a “paid” service

Select “No” if you do not know what this means.

List which Regional Centers you are Vendored with:

Which Regional Centers/Geographic Locations do you provide services in?

please select all that apply:

What other Regional Centers / Geographic Locations do you provide to?

What is your fee policy?

Understand that fees paid for Services in the Self-Determination Program are paid AFTER Services are delivered and reimbursement is not permitted (participant cannot pay you then be reimbursed by FMS)

What languages do you support?

What other trainings and credentials have you obtained that enhance the delivery of your services?

Listing Image:

This image will be the first thing people see when they view your listing, please make sure its professional looking.

Drop files here

Allowed file types: .jpg, .jpe, .jpeg, .gif, .png, .bmp, .ico, .webp, .avif

(You can upload unlimited files with this package)

Please drag & drop the files to rearrange the order

About *

Keep this section at a minimum of 200 Characters. This will be a brief highlight for the Search Section.

Type 64 into this box

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Submit your information to be added to the Independent Facilitator Directory OR Service Provider Directory

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