Self-Determination Forms

Self-Determination Forms to Simplify Your Support

In self-determination programs, both Participants and Direct Care Workers have responsibilities in managing the relationship and making it a positive experience. Our job is to make it simpler and easier for both of you. On this page, you’ll find forms that Participants and Direct Care Workers will need to manage their relationship and comply with requirements and regulations.

Direct Care Worker (Employee) Request Form

↘ Formulario de solicitud del empleado (Employee Request Form - Spanish)

Participant FMS Intake Form

↘ Formulario de Solicitud de Ingreso (Participant FMS Intake Form-Spanish)

Purchase Request Form

↘ Formulario de Solicitud de Compra (Purchase Request Form-Spanish)

Healthcare Stipend Request

↘ Solicitud de Subvención para Cuidado de la Salud (Healthcare Stipend Request-Spanish)

Complaint and Grievance Procedure

↘Procedimiento de Quejas y Reclamos (Complaint and Grievance Procedure-Spanish)

Employment Application

↘ Formulario de solicitud de empleo (Employment Application-Spanish)

IRS Form I-9

Direct Deposit Form

Non-Medical Mileage Log

↘ Registro de Millaje no Médico (Non-Medical Mileage Log-Spanish)

Paid Time Off (PTO) Request

↘Solicitud de tiempo libre pagado(PTO) (Paid Time Off Request-Spanish)

Sick Leave Time Off Request

↘Solicitud de permiso por enfermedad (Sick Leave Time Off Request-Spanish)

Change of Status Form

↘Profesional de cuidados directos forma de cambio de estatus (Change of Status form-Spanish)

Timesheet

↘Hoja de control de tiempos profesionales de cuidados directos (Timesheet-Spanish)

2026 Payroll Schedule

Form W-9

Direct Deposit Form

Vendor Authorization Form

↘ Formulario de Solicitud de Autorización de Proveedores (Vendor Authorization Form-Spanish)

2026 Vendor Payment Schedule

Experience Confirmation Form

Regional Center: SIR Reporting

↘Declaración sobre el procedimiento de sir del centro regional (SIR Reporting-Spanish)

Terms to keep in mind

There are a number of different words used in self-determination to refer to the individuals who contract for and receive services, as well as the individuals who provide those services. Here’s a quick guide to these words and who they refer to on our site and in other resources:

Participant: This refers to the individual contracting for and receiving services. Other common terms include Employer, Member, Client, or Consumer.

Direct Care Professional: This refers to the individual providing services. Other common terms include Caregiver, Care Provider, Provider, Employee, or Direct Staff.

Learn more about the Self-Determination Program in California from the Department of Developmental Services.

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