Group Homes

Offering residential services in the local community for people with intellectual and developmental disabilities.

Services include:

  • In-Home Residential
  • Sponsored Residential
  • Group Homes in Charlottesville and the counties of Albemarle and Nelson.

For more information contact:  Lisa Potts, MSW, lpotts@arcpva.org

Please fill out our application for services below.

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