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Employment Development, Inc.
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Client Application
First name
*
Last name
*
Email
*
Address
*
Phone
*
Birthday
*
Month
Day
Year
Number of days per week you would like to attend? (We are open Monday-Friday)
(If Applicable), Guardians Name:
Do you have a waiver through the Columbiana County Board of Developmental Disabilities (CCBDD) or surrounding counties?
*
Yes, I have a Waiver
No, I do not have a Waiver
Name of SSA:
Do you need Transportation?
*
Yes
No
Additional information
Submit
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Informational Handout
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