UMAR
  • Events
  • Residential Services
  • Vocational Services
  • Arts Centers
  • Donate Now
Select Page

Residential Services Application

Step 1 of 5

20%
  • This application takes 1-2 hours to complete. Please be sure that you have all of your documentation at the time of starting the application and complete in one sitting.

    IS UMAR A FIT FOR ME?

    UMAR serves adults with a PRIMARY DIAGNOSIS of intellectual and developmental disabilities (IDD).
    In order to qualify to receive our services, the applicant's IQ cannot exceed 70.

    If you meet both of the above criteria, we encourage you to apply for our residential, day, and/or vocational services.

  • After submitting the application, you will be required to upload the following materials within 48 hours:
    - Recent psychological report
    - Applicant photograph
    - Medical history
    - Behavioral evaluations/modification plans (if applicable)
    - Current service plan (if applicable)

    If you have any technical issues, please contact marketing@umarinfo.com.

  • Resident Information

  • MM slash DD slash YYYY
  • Family Contact Information

  • Referral Data

  • Legal Guardianship Status

  • MM slash DD slash YYYY
Save and Continue Later
  • Diagnoses - DSM V

  • Axis I - Primary Diagnosis

    Clinical disorders, including anxiety disorders, mood disorders, schizophrenia and other psychotic disorders.
  • NAMENUMBERTYPE
  • NAMENUMBERTYPE
  • Axis II - Personality Disorder

  • NAMENUMBERTYPE
  • NAMENUMBERTYPE
  • Axis III - General Medical Conditions

    These include diseases or disorders that may be related physiologically to the mental disorder; that are sufficiently severe to affect the patient's mood or functioning; or that influence the choice of medications for treating the mental disorder.
  • NAMENUMBERTYPE
  • NAMENUMBERTYPE
  • Axis IV - Psychosocial and Environmental

    These include conditions or situations that influence the diagnosis, treatment, or prognosis of the patient's mental disorder.
  • NAMENUMBERTYPE
  • NAMENUMBERTYPE
  • Axis V - Global Assessment of Functioning (GAF Score)

    Assessed level of functioning is intended to help the doctor draw up a treatment plan and evaluate treatment progress.
  • NAMENUMBERTYPE
  • NAMENUMBERTYPE
  • MM slash DD slash YYYY
  • Physical Health Care

  • DateReasonLocation 
  • DateTypeNotes 
  • Medication NameDosage and FrequencyRoutePurpose of MedicationCompliance Issues 
  • Mental Health

  • Vision, Hearing, and Dental

  • _____ /20
  • _____ /20
Save and Continue Later
  • Current Applicant Services

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Independent Living Abilities

  • Not an IssueMildModerateSevere
    Cries/Screams Excessively
    Excessive Anger
    Excessive Lying
    History of Running Away
    Inappropriate Sexual Behavior
    Physically Assaultive
    PICA/Attempts to Eat Inedibles
    Property Damage
    Self Injurious
    Self Stimulation
    Steals
    Verbally Assaultive
    Behavior
  • Social History

  • WhereWhen 
  • WhereWhen 
  • CityCountyStateDates 
Save and Continue Later
  • Financial Information

  • Source of IncomeMonthly Amount 
  • Real EstateReal Estate ValueOther PropertyOther Property Value 
  • AccountValue 
  • Insurance Information

Save and Continue Later
  • Certification

  • Applicant Statement

  • Required File Uploads

    The following materials are required within 48 hours of submitting your application:

    - Recent psychological report
    - Applicant photograph
    - Medical history
    - Behavioral evaluations/modification plans (if applicable)
    - Current service plan (if applicable)

    If you have any trouble uploading the files, please mail copies to the following address:

    UMAR Services, Inc.
    Attn: Admissions
    5350 77 Center Drive, Suite 201
    Charlotte, NC 28217
    Email to: admissions@umarinfo.com
  • Drop files here or
    Accepted file types: jpg, pdf, Max. file size: 1 MB.
    Save and Continue Later

    ABOUT US

    Accreditation
    History
    Leadership
    Locations
    UMAR Stories
    Honor Roll of Donors

    RESIDENTIAL

    Licensed Homes
    Independent Living
    Community Services
    Current Openings
    Apply for Residence

    DAY PROGRAMS

    Arts Centers
    Apply to an Arts Program

    VOCATIONAL

    Skills Assessment
    Supported Employment
    Work Adjustment

    QUICK LINKS

    Support UMAR
    Church Resources
    Employment
    Residential Application
    Artist Application
    Volunteer
    Events

     

     

     

    • Follow
    • Follow
    • Follow
    • Follow

    Click here to sign up for UMAR emails.

    5350 77 CENTER DR. SUITE 201 CHARLOTTE, NC 28217 | 704.875.1328​

    Copyright ©2022 UMAR Services, Inc. | All rights reserved.