Contract Renewals for CHOICE, TITLE 3 and SSGB

Current Providers:

Contract renewals must be completed prior to June 30 of the year the contract ends. All providers must complete an updated Provider Profile that will need to be returned via online application or 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 10 and 11 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 18 and 23 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