Application for Admission

 

Instructions

Thank you for your interest in Elk Hill and the programs we provide young people throughout central Virginia.

 

Download application form

To make a referral, please download and complete the Application for Admissions above. The more thoroughly the application is completed, the more helpful it will be in making an appropriate Admissions decision.

Also required for consideration of Admission are the following informational documents:

  • Psychological Evaluation (within the past year) with a Full Scale IQ and all 5 DSM-IV Axis’s completed
  • Social History (within the past year)
  • Current IEP and most recent school transcript
  • Educational evaluations and test scores
  • Copy of FAPT/Treatment plan
  • Proof of Active Health Insurance
  • Immunization Records
  • Copies of youth’s Birth Certificate and Social Security Card
  • Letter of Program Completion and Letter of Therapist Recommendation if stepping down from a higher level
    of care

Once these items have been reviewed and appropriateness of the youth has been considered, an interview as well as an admissions/pre-placement visit date will likely be set. At the time of admissions/pre-placement visit, we will also need the following:

  • Certificate of Need (signed within 30 days of Admission Date)
  • CANS Assessment (completed within 30 days of Admission Date)
  • Current physical exam (within the past 90 days)
  • TB skin test 30 days prior to admission
  • Standing Medication Order from a medical doctor to receive over the counter medications
  • Missed Medication Protocol form must be completed by the prescribing doctor for any prescription
    medication(s) the youth is taking
  • Date of last Dental Exam and contact information for current dentist
  • Statement of any special needs
  • A 4-6 week supply of current medications

Please use the above list as a checklist. If you have any questions please do not hesitate to contact the Elk Hill Admissions Coordinator at 804-457-4866 ext. 342. We look forward to working with you, and again thank you for your interest in our program.