Children’s Extraordinary Needs Program Waitlist Request Form

The Children’s Extraordinary Needs (CEN) Program is operated by the Oregon Office of Developmental Disabilities Services (ODDS). The CEN Program is for children under 18 with very high medical or behavior needs. Parents and guardians can be paid to provide care to their enrolled child. Due to limited funds, the program has a waitlist.


To be added to the CEN waitlist, complete and submit the CEN waitlist request form. ODDS will notify the parent or guardian once your child has been added to the CEN waitlist. If you have any questions regarding your submission, email cenprogram@odhs.oregon.gov.





Not all fields are *required, however, we ask that you please complete as many optional fields as you are able.

 

Referral Source

 
 
 

Child’s Personal Identification Information

 
 
 
 
 
mm/dd/yyyy
 
 
 
 


Also referred to as Oregon Medicaid ID number

 
 

Child's Contact Information

 
 
 
 
 
 
 
 

Child's Identity Expression (OPTIONAL)

So that we may more successfully support this child, please let us know more about how they identify.

 
 

(Select all that apply)

 


The sex, male, female or intersex, that a doctor or midwife uses to describe a child at birth based on their external anatomy.

 


External appearance of one's gender identity, usually expressed through behavior, clothing, body characteristics or voice, and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine.