Application For Services Forms

 

Print out the form for the Region in which you live.

These forms are also available in fill-in-format that you can download and complete on your computer.

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Complete and return to:

  • Central Maryland Regional Office

DDA - CENTRAL MARYLAND REGIONAL OFFICE
1400 Severn Street
Suite 200
Baltimore, MARYLAND 21230

If you have questions call: (410)902-4500.

  • Eastern Shore Regional Office

DDA - EASTERN SHORE REGIONAL OFFICE
ATTN: ELIGIBILITY AND ACCESS UNIT
1500 RIVERSIDE DRIVE, SALISBURY MD 21802

If you have questions call: (410)334-6920; toll free 1-888-219-0478.

  • Southern Maryland Regional Office

GAIL SINGLETARY, ELIGIBILITY UNIT
SOUTHERN MARYLAND REGIONAL OFFICE
312 MARSHALL AVENUE, SUITE 500
LAUREL, MARYLAND 20707

If you have questions call: (301)362-5100; toll free 1-888-207-2479; TDD (301)362-5131.

  • Western Maryland Regional Office

DDA - WESTERN REGIONAL OFFICE
1360 MARSHALL STREET
HAGERSTOWN, MARYLAND 21740

If you have questions call: (301)791-4670; toll free 1-888-791-0193

The freely available Adobe Acrobat Reader is required to view and print PDF files.

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Fill-in-forms

Fill-in forms allow you to enter information while the form is displayed by an Adobe Acrobat 3.0 (or later) product and then print the completed form out or save it. Fill-in forms give you a cleaner crispier printout for your records and the ability to email your completed form to us.

Please review the fill-in-form instructions for software requirements and detailed instructions on the usage.

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Fill-in Forms Instructions

Overview

Fill-in forms use the features provided with Acrobat 3.0 products. Currently, there is no computation, validation or verification of the information you enter and you are still responsible for entering all required information.

Software Requirements

To view, complete and print fill-in forms you'll need the freely available Acrobat Acrobat Reader software installed on your computer. Acrobat Reader does not allow you to save your completed forms to disk. The ability to save completed forms is available commercially with the Adobe Acrobat 3.0 (or later) product suite.

Completing the Form

  • To download the form your web browser may be configured with an Acrobat plug-in to automatically open the file within your browsers window upon download. To save the file directly to disk right click on the link then select "Save Target/Link As.." when presented with a menu.
  • Use Acrobat 3.0 to open the file if necessary.
  • Select the hand tool from the Acrobat toolbar menu. You can use the hand tool to move the page around so that you can view all the areas on it.
  • Position the hand pointer inside a form field and click. The I-beam pointer allows you to type text. The arrow pointer allows you to select a check box, a radio button, or an item from a list.
  • Use your mouse to select an area of the form that is not inside a form field before printing your form. If a form field is active (contains the blinking bar) the contents will not print. You may also use the save tab to save your form.
  • If the fill-in form is displayed within your web browsers window be sure to use the printer button on the Acrobat toolbar menu to print the form instead of your web browsers print function.

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