How Do I Get Started?
Completing the Online Application
To complete the intake application online you will need:
- Access to a printer
- Access to a scanner or Access to an app scanner
If you do not have access to a scanner to upload the required supporting documentation, you may download a fillable PDF application using the links below. The PDF version of the intake application exists in two parts.
Part 1: Intake Application
- Request for Determination of Developmental Disability (pgs. 1-4)
- Needed Documents for Determining a Developmental Disability (pg. 5)
Part 2: Additional Forms and Information
- Affidavit (pg. 6)
- Grievance and Complaint Procedure (pgs. 7-10)
- Your Rights (pgs. 11-13)
- Rights and Releases (pg. 14)
- Notice of Privacy Practices (pgs. 15-28)
- Acknowledgment of Receipt of Notice of Privacy Practices (pg. 29)
If you choose to download the intake application please send your application and supporting documentation to the Intake Navigator. You can also scan and email the paperwork to email@example.com. You can either mail your application or drop off your application at Imagine!.
Attn: Intake Navigator
1400 Dixon Ave.
Lafayette, CO 80026
For children under the age of 3
If the person you are referring for Imagine! services is under the age of three, you may access the Early Intervention page to learn more.
For children between the ages of 3 and 5
If the person you are referring for Imagine! services is between the ages of three and five, please complete the Imagine! Intake application and provide supporting documentation of a developmental delay.
In Colorado, a developmental delay is defined as
Developmental Delay means that a child meets one or more of the following:
- 1. A child who is less than five (5) years of age at risk of having a developmental disability because of the presence of one or more of the following:
- Chromosomal conditions associated with delays in development,
- Congenital syndromes and conditions associated with delay in development,
- Sensory impairments associated with delays in development,
- Metabolic disorders associated with delays in development,
- Prenatal and perinatal infections and significant medical problems associated with delays in development,
- Low birth weight infants weighing less than 1200 grams, or
- Postnatal acquired problems resulting in delays in development.
- Adaptive behavior,
- Sensory, or
For children and adults ages 5+
If the person you are referring for Imagine! services is five years old or older, please complete the Imagine! Intake application and provide the following supporting documentation:
- A qualifying neurodevelopmental diagnosis
- A full scale IQ or adaptive score of 70 or below
You may access the criteria for an intellectual / developmental disability determination below.
The Colorado Rules effective 8/30/2019 (10 CCR 2505-10 Section 8.600) define Developmental Disability as a disability that:
A. Is manifested before the person reaches twenty-two (22) years of age;
B. Constitutes a substantial disability to the affected individual, as demonstrated by the criteria below at C.1 and/or C.2; and
C. Is attributable to an intellectual and developmental disability or related conditions, which include Prader-Willi syndrome, cerebral palsy, epilepsy, autism or other neurological conditions, when such conditions result in either impairment of general intellectual functioning or adaptive behavior similar to that of a person with an intellectual and developmental disability.
1. Impairment of "general intellectual functioning" means that the person has been determined to have a Full Scale intellectual quotient which is two or more standard deviations below the mean (70 or less assuming a scale with a mean of 100 and a standard deviation of 15).
a. A secondary score comparable to the General Abilities Index for a Wechsler intelligence scale that is two or more standard deviations below the mean may be used only if a Full Scale score cannot be appropriately derived.
b. Score shall be determined using a norm referenced standardized test of intellectual functioning comparable to a comprehensively administered Wechsler intelligence scale or Stanford-Binet intelligence scales, as revised or current to the date of administration. The test shall be administered by a licensed psychologist or a school psychologist.
c. When determining the intellectual quotient equivalent score, a maximum confidence level of ninety percent (90%) shall be applied to the Full Scale score to determine if the interval includes a score of 70 or less, and shall be interpreted to the benefit of the applicant being determined to have a Developmental Disability.
2. "Adaptive behavior similar to that of a person with intellectual disability" means that the person has an overall adaptive behavior composite or equivalent score that is two or more standard deviations below the mean.
a. Measurements shall be determined using a norm-referenced, standardized assessment of adaptive behaviors that is appropriate to the person’s living environment and comparable to a comprehensively administered Vineland scale of adaptive behavior, as revised or current to the date of administration. The assessment shall be administered and determined by a professional qualified to administer the assessment used.
b. When determining the overall adaptive behavior score, a maximum confidence level of 90 percent shall be applied to the overall adaptive behavior score to determine if the interval range includes a score of 70 or less and shall be interpreted to the benefit of the applicant being determined to have a developmental disability.
D. A person shall not be determined to have a Developmental Disability if it can be demonstrated such conditions are attributable to only a physical or sensory impairment or a mental illness.
For our Autism Spectrum Disorder Program
The ASD program has different criteria than other Imagine! Programs. If you are interested in the ASD program and would like to learn more, you may access the ASD program webpage or contact the intake navigator.