CHOICE, TITLE 3 and SSGB Contracts for July 1, 2019 – June 30, 2021

Current and New Providers:

Contracts must be completed prior to June 30, 2019. All providers must complete an updated Provider Profile that will need to be returned via online application or a PDF application sent through email to provider@cicoa.org. Providers will need to select the appropriate contract as it pertains to your agency. Home modification contract agreements should be completed by all home mod providers. All other agencies will need to complete the In-Home Services Contract Agreement.

Home modification providers will need to read the contract agreement, print, sign and scan pages 9 and 10 of the Home Modification Contract Agreement to provider@cicoa.org.

In-Home service providers will need to read the contract agreement, print, sign and scan pages 19, 25 and 32 of the In-Home Services Contract Agreement to provider@cicoa.org.

Direct any questions to Chad Bales, assistant director of in-home services, at 317-803-6093 or provider@cicoa.org.

Provider Profile

Download

(or Online Form)

In-Home Services Contract Agreement

Download

Home Modification Contract Agreement

Download