Recreation Application

Please complete the following application for AIM’s Recreation program.

Before you begin, please be sure to have the following information ready:

  • Emergency contact information
  • Medicaid number
  • Other Insurance information (if applicable)
  • Diagnosis, allergies and medications
  • Care Manager contact information
  • Self Direction Support Broker and Fiscal Intermediary contact information (if applicable)
  • Participants interests and fears
  • Participants medical or dietary precautions, and adaptive equipment needs (including for transportation)

Please contact your Care Manager and have them submit the following paperwork to

  • 2 most current Life Plans
  • Service Authorization (NOD.9)
  • HCBS Waiver (NOD.1)
  • OPWDD Determination of Eligibility
  • Current Level of Care Eligibility of Determination (LCED)
  • Consent/Authorization Forms Signed or Declined

Please note, once your application and paperwork is received, the participant will begin Recreation on a trial basis.

If you have any questions, please contact Audrey Marion at