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Participant Application

*Note: All fields marked with an asterisk (*) are required.

Do not complete this application unless you are a participant, guardian, or a TSC who has received and completed a release of information to share participant information with St. Fillan's, LLC. Information entered into this page will be kept as a secure document, unavailable to anyone except authorized St. Fillan's staff.

*Participant First Name

Participant Middle Name

Participant Last Name

*Gender

Male

Female

*Date of Birth

*Best Contact Number

*Proposed Start Date

*TSC Name

*TSC Company

*TSC Contact Number

*TSC Email

If you do not have a guardian, please enter 'Self'.

Guardian Name

Guardian Relationship

Guardian Best Contact Number

Guardian Email

*Primary Diagnosis

Secondary Diagnosis

*Level of Care

High

Intense

Hourly

How many hours per week?

Required

Contact St. Fillan's

Office Phone: 208-884-5139
Office Fax: 208-884-5703

1520 E. Heritage Park St. Ste 100
Meridian, Idaho 83646

About

About Us
Contact
Participant Application
Classes

Services

We offer a range of services to our participants, from finding housing to providing daily living services.

Our Serivces

Employment

We're looking for highly-motivated, caring people who are passionate about serving our participants.

Learn More

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