Charlottesville Day Support Program

The Charlottesville Day Support Program is located at 1149 Rose Hill Drive in Charlottesville, VA. The Day  Support Program assists adults with intellectual and developmental disabilities to be more independent, learn new things, visit new places and make new friends. We provide individualized training in daily living skills, socialization and communication. Activities and experiences are designed to enable individuals to achieve their highest potential in interdependence and participation in the community. Please fill out our application for services below.

 

For more information contact:

Application for Services

  • APPLICATION: COMMUNITY SUPPORT SERVICES

  • Personal Information

  • Date Format: MM slash DD slash YYYY
  • GUIDELINES

  • Emergency Contact Person

  • Emergency Orders
  • SOCIAL & DEVLOPMENTAL SUMMARY

  • FAMILY SUMMARY

  • home
  • Work/cell
  • home
  • Work/ Cell
  • MEDICAL HISTORY

  • Indicate if the Applicant has any of the following illnesses, and/or chronic conditions

  • MEDICATION PROFILE

  • NameDosageTimes TakenReasonSide Effects 
    Click + on right to add more
  • SUPPORT

  • HISTORY OF RESIDENTIAL TREATMENT OR INSTITUTIONALIZATION:

  • Name of Agency or InstitutionAddressDates (to/from) 
    Click + on right to add more
  • Agency/ ProfessionalDates (to/from)Contact Person/ Case Manager 
  • Date Format: MM slash DD slash YYYY
  • FOR OFFICE USE ONLY

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY

Karen O’Rourke
Deputy Director for Program Services
(434)977-4002 or korourke@arcpva.org