June 2017
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Please Fill out the Referral Form Listed under Grace Cottage.

Items Required for Admission
1. Social Security Card
2. Birth Certificate
3. All current medical history
4. Mental Health History
5. Proof of Pregnancy
6. Current Medicaid or other insurance card
7. Immunization record
8. School course schedule
9. School transcripts
10. I.E.P. for Special Education Student
11. Court Order establishing child is in State custody(if applicable)
12. Custody order for child of divorced parents (custodial parent must approve admission).
13. Clothing Order or contingency voucher for child in State custody.
14. History of Delinquent Behavior.
15. Out of home Placement History.

Additional Items Needed
1. Conservative clothing that fully covers boobs, bellies and booties (5 changes if possible, but not required.)
2. Bras, panties and socks (5 changes if possible, but not required)

Items Not Needed
1. Grace Cottage provides hygiene products.
2. Bedding is provided. Do not bring extra bedding (a favorite pillow is acceptable.)
3. Do not bring computers, cell phones or technical equipment(I-pods or walk-man style CD players are acceptable.