Community Rehabilitation Program Application Form - Utah State Office Of Rehabilitation
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1.
CRP Application
2.
Vendor Information Form
3.
Accessibility Assurance Form
4.
Civil Rights Certificate
5.
A brief description of some laws affecting programs used by USOR.
6.
USOR Standards
Instructions for completing Facilities Packet. These instructions refer to the numbered items above.
1.
Read, fill out completely and sign- return to Rehabilitation
2.
Read, fill out completely and sign - return to Rehabilitation
3.
Read, check appropriate boxes and sign - return to Rehabilitation
4.
Read and sign - return to Rehabilitation
5.
Read - keep for reference
6.
Read - keep for reference
Complete the application and sign the assurances and other documents. Include copies of
your admission criteria and fee schedule. Return all these items to:
Jeff Pitts - Facilities Specialist
Utah State Office of Rehabilitation
1595 West 500 South
Salt Lake City, UT 84104
jeffpitts@utah.gov
If you are have questions or would like further explanation of any of the form or the application
process, please contact Mr. Pitts by mail at the above address, email to (jeffpitts@utah.gov) or call
him at (801) 887-9504.
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