Family Support Renewal Agreement FY 2025-2026

Thank you for applying for Family Support Funding with Georgia Community Support & Solutions dba InCommunity. Please verify that you have received family Support Funding for the 2025-2026 funding year. If you did receive funding, please continue. If not, you will have to submit a new application with our Agency.*

We received funding for the 2024-2025 fiscal year with InCommunity.We received funding with another Agency during the 2024-2025 fiscal year.
Notification of Denial of Application.

Good day Applicant,

We thank you for applying for Family Support Funding with InCommunity. We are unable to provide funding resources to you because you had an active account with another Agency. You have to submit a letter of release from that Agency and submit it to our office along with a new Family Support Application.

Once we receive your release letter along with your submitter application, we will submit your application to the department of Behavioral Health and Developmental Disabilities for your approval. We cannot determine the length of time it will take for your approval to return back to our office.

We appreciate you considering InCommunity for your funding needs. Thank you again upon availability of funds,we look forward to serving your family once your application returns to our office.

Family Support Team
Date of Submission:*

MonthDayYear
Date
InCommunity Embracing the abilities in all of us.
Family Support Renewal Agreement For:*

First NameLast Name
Date of Birth:

MonthDayYear
Date
Parent/Guardian Name:*

First NameLast Name
Email Address:*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RE: Family Support Renewal FY 2025-26

Thank you for your renewal application with Geoprgia Community Support & Solutions (GCSS) dba InCommunity. As a team and based on your participation in the program last year, we are in the preparation of sending out the new Family Support Award for the upcoming Fiscal Year.
You have been deemed eligible for Family Support funding and Respite Care. New allocations for both fundings will be sent to you via an Award Letter Email within 10 business days of your submisson of this renewal document. We have included your Individual Family Support Plan (IFSP) documentation for you to complete. If all of the requested information is not received to us upon submission, this could delay your award letter being sent to you.

Please complete all of the fields that are on the form and click on the SUBMIT button on this document. DO NOT PRINT this document and submit it to our office. We will not accept any documentation that is faxed, mailed, or emailed submitted to our office.

We retain the right to adjust or to amend funding amounts or verbage on this form at anytime.

ATTENTION: All renewals should be submitted by October 1st 2025.

If you have any questions, regarding this correspondence, you can reach us at the email below.
familysupport@incommunityga.org

Please retain your Email Award Letter upon receipt for your records.
Let's have an amazing year.
Thank you ,
Family Support Team
InCommunity Embracing the abilities in all of us.

INDIVIDUAL FAMILY SUPPORT PLAN (IFSP)
Person Centered Profile
Date of Plan Start: July 1, 2025 Date of Plan End: June 30, 2026
Date of Plan Start: July 1, 2025 Date of Plan End: June 30, 2026
Description of Applicant:
What is Important to the applicant's family for them to maintain a good quality of life?*
Current Support Network
Current Services Information: Current Services Received: List all current services/resources utilized by the applicant and family below:*

New Options Waiver (NOW)Currently on DBHDD Planning ListICWPCCSPDeeming Waiver (Katie Beckett)Vocational RehabilitationFood StampsIndividual Educational Plan (IEP)ADRC-Options CounselingComprehensive Waiver (COMP)SOURCEGAPPDBHDD State Funded ServicesChild Care Assistance (CAP)Adoption AssistanceSocial Security Disability (SSDI)Other
Services Needs/Request Please check the services/goods your family has identified as needing*

RespiteCommunity AccessMedical/Dental/Vision careSpecialized Medical Supplies & Specialized ClothingNutritionAfter School CareRecreational/Social Integration ActivitiesBehavioral Support and ConsultationTherapeutic Services/Environmental ModificationTransportation/Vehicle Adaptation ServicesOther
Did you receive Family Support or are on a waiting list with another Agency last year?*

YesNo
Have the services/goods identified above been denied through other agency sources*

YesNoWe have not applied for other goods or services
Describe the benefit to the family if you received this funding?*
InCommunity Embacing the abilities in all of us.
PROPOSED FUNDING AMOUNTS FOR 2025-2026:

FAMILY SUPPORT BUDGET: TBD (Based on goods/ services requested).

RESPITE SERVICES BUDGET: $3,000.00
DISCLAIMER:(Please read in it's entirety)

Georgia Community Support & Solutions dba Incommunity,has the right to withdraw awarded Family Support funds if they are not utilized within the first 90 days of the signed Family Support Plan. I/We attest that we were informed of our right to participate in the development of this Individualized Family Support Plan, and were given the ability to identity services and goods based on my/our family priority of needs for services/goods. I/We understand that Family Support Services is a non- entitlement program and InCommunity dba Georgia Community Support and Solutions cannot fund all the service and goods that I/We may request, and that funding levels can and might change from each funding year and are subject to funding limitations. I/We agree with the Individual Family Support Plan, Family Support Agreement, and the disclaimers above:
Your Answer to the above disclaimer*

YesNo
Parent Signature*

Clear
Person Submitting This Form*

First NameLast Name
Signature Date*

MonthDayYear
Date
Family Support Staff
Date

MonthDayYear
Date
Should be Empty:

Person Centered Profile

Date of Plan Start: July 1, 2025 Date of Plan End: June 30, 2026

Date of Plan Start: July 1, 2025 Date of Plan End: June 30, 2026

Current Support Network