Skip to main content

Admission Inquiries

Get Started

Thank you for your interest in Merrick, Inc. To start the application process, we ask that you complete and submit the following application form.

The application includes general questions about the individual to be served, their desired service area, diagnosis, funding type, vocational history, and contact information for their support team. At the end of the application, you will be required to upload the following documents.

  • Coordinated Service and Support Plan (CSSP)
  • Coordinated Support Plan (CSP)
  • Psychological Assessment

Please have these documents ready as the application cannot be saved. Lastly, please note that the prospective client must have a DSM11 diagnosis documented by a licensed psychologist, psychiatrist, physician, or other qualified professional. If you have additional questions regarding intake, referrals, or transition, please contact

Kristine Orubo
Program Director
(651) 789-6206

Admission Application

Fill out my online form.