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Please indicate your Prince George’s CountyDD operating budgeted amount for FY24*:

(Provide your best estimate if you are a multicounty provider and don’t have a solid budget number by county.)

Approximate number of Prince George’s County residents to be served as of
July 2023 

Approximate number of Direct Support Professionals serving Prince George’s County residents as of July 2023

Total dues owed for Prince George’s Provider Council Membership FY24:

Agency:  *

Agency Representative Name :

Agency Representative Email :

Agency Representative Preferred Phone # :

Agency:  

Agency Representative Name :

Agency Representative Email :

Total dues owed for Prince George’s Provider Council Membership FY24:

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