*To register you must have an e-mail address,
if you do not have an e-mail address you may obtain a free one
at sites such as http://hotmail.com or http://yahoo.com
Mission: To assist individuals with disabilities to live independently, pursue meaningful goals, and have the same opportunities and choices as all persons.
CILNM Philosophy: The Center for Independent Living of Northeastern Minnesota (CILNM) is a private, non profit, community organization, serving persons of all disability groups within eight northeastern Minnesota counties. CILNM promotes and practices the independent living philosophy of consumer control regarding decision-making, service delivery, management, and establishment of the policy and direction of the center.
Through self help and self advocacy, and the development of peer relationships and role models, CILNM assists individuals with disabilities to live independently, to exercise equal rights and choice; and, to have opportunities to access services available to all, regardless of the funding source or ability to pay. These services include programs, activities, resources, and facilities within their communities.
Increased options, access, and independence are achieved through the provision of information and referral, independent living skills training, peer support, advocacy and community education and involvement.
I understand that as a consumer of CILNM, initiating services and maintaining follow through is my responsibility. I understand that CILNM staff is available to assist me in attaining my personal goals, and that I am responsible for setting my goals and making decisions regarding my life.
I First Name:
Last Name:
WISH TO BE CONSIDERED A CONSUMER OF INDEPENDENT LIVING SERVICES AT CILNM.
(Choose One Of The Two Below)
I wish to have staff assist me in developing an independent living plan.
It is my personal determination that a formal independent living plan is not necessary at this time. I understand that I am entitled to all CIL services without a formal plan. I also understand that I have the right to develop an independent living plan at a later time should I so desire.
I have received CILNM policies A/3 and A/6 (Policy and Procedure Concerning the Reporting of ConsumerAbuse and Neglect and Policy and Procedure Concerning Consumers and Employees Communicating Concerns and Registering Complaints). I understand these CILNM policies and I have been informed of the Client Assistance Project.
I have been notified in accordance with the Minnesota Government Data Practices Act and HIPPA that CILNM is required a provide grant activity reports to the Division of Rehabilitative Services (DRS) and the Department of Human services (DHS). I understand that my signature below authorizes CILNM to provide information about me as part of their required grant reporting process. The DHS and DRS will use this information only for grant administration purposes, and will not release my name or personal information to other parties without my informed consent (or the consent of my guardian or legal representative where necessary).
I DisAgree To Everything Written Above
I Agree To Everything Written Above
After you click ENTER you will be requested to complete a brief informational form before you can participate in the Online services.
The information that you provide is covered by the Data Privacy Act and will not be shared outside of the CILNM team. We WILL NOT share your personal information with ANY outside agency outside of what is provided for in Policy A/3 & A/6 for your personal protection and/or the protection of others.
