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Mental Health and Disability Services
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Eligibility Screener
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Are you filling out this screener for yourself or someone else?
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for myself
someone else
Your Information
What is your name
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First
Last
What is your phone number?
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What is your email
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What is your relationship to the applicant?
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Applicant Information
Name
*
First
Last
Email
*
Phone
*
Address
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City
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State
Zip Code
*
Which county do you live in?
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Des Moines
Jefferson
Keokuk
Louisa
Henry
Lee
Van Buren
Washington
Other
Thank you for your interest in our programs. Unfortunately, we do not have services in your county.
How many people live in your household?
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Are you a Veteran
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Yes
No
Eligibility Criteria
What year were you born?
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Are you a lawful resident of Iowa?
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Yes
No
Are you currently receiving services that are funded by the SEIL region?
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Yes
No
Please contact your local Coordinator of Disability Services (CDS) to see if you need to update your application. To find the a local access office
Local Access Office
Are you currently receiving services that are funded by Medicaid?
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Yes
No
Do you have Iowa Medicaid or other health insurance?
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Yes
No
Do you receive SSI or SSDI from Social Security?
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Yes
No
What is your gross household monthly income?
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Do you meet resource guidelines of $2,000 per individual / $3,000 per household?
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Yes
No
I'm not sure
Click here to see the State Resource Guidelines:
State Supplementary Information
To receive assistance from Southeast Iowa Link, you will need to meet the resource guidelines.
Do you have a medical diagnoses for one of the following (select all that apply)
Mental Illness
Intellectual Disability
Developmental Disability
Other Diagnoses
I do not have a medical diagnoses
To receive assistance from Southeast Iowa Link, you will need to have a medical diagnoses
Have you completed a Mental Health and Disability Services application?
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Yes
No
I'm not sure
Click here to find a local SEIL office:
Where to apply
What service are you needing?
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