Request For Services

Request For Services

Disability Verification Form

*REQUIRED*
SHP Disability Definition

A person with disabilities means a household composed of one or more persons at least one of whom is an adult with a disability.

1. A person shall be considered to have a disability if such person has a physical, mental or emotional impairment which is expected to be of a long continued and indefinite duration; substantially impedes his or her ability to live independently; and is of such a nature that such ability could be improved by more suitable housing conditions.

2. A person will also be considered to have a disability if he or she has a developmental disability, which is severe, chronic disability that

    a. Is attributable to a mental or physical impairment or combination of mental and physical impairments;
    b. Is manifested before the person attains age 22;
    c. Is likely to continue indefinitely;
    d. Results in substantial functional limitations in three or more of the following areas of major life activity:
        i. Self Care
        ii. Receptive and expressive language
        iii. Learning
        iv. Mobility
        v. Self Direction
        vi. Capacity for independent living, and
        vii. Economic self sufficiently and
        viii. Reflects the person's need for a combination and sequence of special interdisciplinary or generic care, treatment or other services which are of lifelong or extended duration and are individually planned and coordinated.

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An electronic signature, made by checking the box below, is equivalent to a signature on paper.

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