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For Office Use Only/Date Stamp Intent to Apply For Waiver Services This form is to be utilized for individuals who have already applied for LTC Medicaid and now intend to apply for waiver services
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How to fill out intent to apply for:

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Make sure to read and understand the instructions provided with the application form.
02
Begin by providing your personal information such as your full name, date of birth, and contact information.
03
Fill in any required identification numbers or social security numbers, if applicable.
04
Clearly state the purpose of your application and provide any necessary supporting documents.
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Double-check all the information provided to ensure accuracy and completeness.
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Sign and date the application form, if required.
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Send the completed application form along with any supporting documents to the appropriate address or submit it online, following the specified instructions.

Who needs intent to apply for:

01
Individuals who are seeking employment may need to submit an intent to apply form to express their interest in a particular job or position.
02
Students who wish to apply for admission to a school or university typically need to submit an intent to apply to demonstrate their enthusiasm and commitment.
03
Businesses or organizations that want to participate in a competitive bidding process for contracts may need to submit an intent to apply form to indicate their intent to submit a proposal.
Note: The specific requirements for an intent to apply form may vary depending on the purpose and the organization or institution to which it is being submitted. It is always advisable to carefully review the instructions provided with the application form and seek any necessary clarification before filling it out.
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