Orange County, NY · Orange County
Children Single Point of Access Application
This application helps caregivers and referral sources request Children’s Single Point of Access coordination for a youth in Orange County.
At a glance
- Issued by
- City of Orange County · Orange County, Orange County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- orangecountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The Children’s Single Point of Access application collects information to support coordination of services for a youth. Complete it to apply for C-SPOA Coordination; for Youth Assertive Community Treatment, Children’s Community Residence, or a Residential Treatment Facility, the form says to submit it with C-SPOA Application Part 2. It asks about the youth’s identity, needs, providers, caregivers, and consent for information sharing.
Who needs it
A caregiver, legal guardian, or referral source seeking C-SPOA Coordination for a youth should complete and submit this application.
How to submit it
Submit the completed form to the youth applicant’s C-SPOA of origin. For Youth ACT, CCR, or RTF, submit it with C-SPOA Application Part 2 to C-SPOA.
About notarization
This document is signed and dated without a notary; the application does not request a notarized or sworn attachment.
How to submit this form
- 1
Download the Application
Download the Children’s Single Point of Access Application PDF.
- 2
Complete the Form
Fill in the youth’s identifying information, caregiver details, referral reason, and requested service information.
- 3
Gather Any Additional Information
Attach an additional sheet if needed to explain the reason for referral; include C-SPOA Application Part 2 for Youth ACT, CCR, or RTF.
- 4
Submit to C-SPOA
Send the completed application to the youth applicant’s C-SPOA of origin.
Frequently asked questions
- Do I need a notary for the Children’s SPOA application?
- No. This application is signed and dated without a notary, and it does not request a notarized or sworn attachment.
- How do I submit the Children’s SPOA application?
- Submit the completed form to the youth applicant’s C-SPOA of origin. For Youth ACT, CCR, or RTF, submit it with C-SPOA Application Part 2 to C-SPOA.
- What information does the application ask for?
- It asks for youth and caregiver details, referral reasons, diagnoses, providers, service history, and consent choices for information sharing.
- When is C-SPOA Application Part 2 required?
- The form says to submit Part 2 with this application when applying for Youth Assertive Community Treatment, Children’s Community Residence, or a Residential Treatment Facility.