MassAbility

MBY Connect: Expanding what's possible, now online.

At MBY, we aim to bring a personal touch to our work. These days, as we spend more time online, we want to make it as easy as possible for you to learn more about us and access our services from home. Completing an online application connects you to a broad range of services for Career Services and Community Living.

As part of this application, MBY will need to collect some personal and/or sensitive information to apply for MBY services. The information collected from respondents is kept strictly confidential, which includes:

  • Citizenship information
  • Dates of birth
  • Email addresses
  • Home addresses
  • Medical documentation
  • Permanent resident number (referred to as alien registration number in this form for legal purposes)
  • Phone numbers
  • Social security numbers

Please note, that you will need to complete this application in its entirety because you are unable to save and continue. On average, this application may take 25 mins or longer to complete and you will need to complete the application in one sitting. Again, if you need assistance completing the online application, call 617-204-3665 or email us at massabilityconnect@mass.gov, open from Monday through Friday 9:00am to 5:00pm.

Our MBY staff will be there with you through every step of the application process to connect you with the programs that are the right fit for you.

You do not need a fixed address or phone number to apply for MBY, but MBY does need a way to reach you to complete your online MBY application. If you do not have an address we can send mail to, please call MBY Connect at 617-204-3665 or go to your local MBY office.

Disclaimer: When this application refers to “I” or “you” we are referring to the individual applying for services. If you are filling this application out on behalf of someone else, please assume that when the application says “I” or “You” it is in regard to the person you are responding on behalf of.

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Who is Applying?





Is this individual a participant of the Waiver Demo?

Because you indicated you are not the applicant filling out this form please enter your contact information:

Does MBY have the individual's consent to speak with you regarding this application?

About Me

Use format MM/DD/YYYY.

9 characters. Use only 0 to 9.

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5 characters. Use only 0 to 9.

Please provide a proper email address.

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Yes


5 characters. Use only 0 to 9.

Please provide a proper email address.

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Race









Use format MM/DD/YYYY.

Use format MM/DD/YYYY.

Are you receiving services from any other state agencies?





















Medical Information

Please select the disabilities you experience using the list below. Please select all that apply.






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Primary Care Physician Information

Please estimate the dates if you are unsure.

Use format MM/DD/YYYY.

If you are still receiving services from the hospital you can leave this date blank.

Use format MM/DD/YYYY.

Please estimate the dates if you are unsure..

Use format MM/DD/YYYY.

If you are still receiving services from the hospital you can leave this date blank.

Use format MM/DD/YYYY.

Have you ever received any of the following treatments listed below related to your disability?






You have indicated needing help applying for health insurance, please use this link below to find out if eligible and how to apply for MassHealth, Health Safety Net, and the Children's Medical Security Plan.

Click Here for Help

Services and Supports

MBY provides services that break down barriers and empower people with disabilities to live life on their own terms.

Home Care

The Home Care supports people with disabilities needing in-home support that include house cleaning, laundry, meal preparation, grocery shopping, and medication pick-up.

Statewide Head Injury Program

The Statewide Head Injury Program (SHIP) provides services to individuals living with a traumatic brain injury to assist them with living in the community, including skills training, adult companions, residential services, shared living, and access to Brain Injury Community Centers.

Supported Living

The Supported Living Program (SL) assists youth and adults ages 16 and up with severe physical disabilities to live independently in the community. The program supports individuals in managing their daily affairs, such as managing Personal Care Attendants, paying bills and money management, finding, or maintaining housing, coordinating health services, and/or obtaining and maintaining durable medical equipment.

Career Services

The Career Services Program helps job seekers and students with disabilities to obtain, maintain, and advance in employment in the modern workplace. If you are unemployed or underemployed, or seeking work for the first time, our services may be able to help you with going to work, returning to work, or advancing in your job. MBY CS also provides job training services and services to students with disabilities to assist them in transitioning from school into the workforce.

Next Gen Program

The MassAbility (MBY), and NextGen Careers is a new initiative to help young adults (ages 18-30) to explore the world of work. Next Gen-ers learn to advocate for themselves, gain confidence, and fast-track their job journey. NextGen-ers will learn to advocate for themselves, gain self-confidence, and become self-sufficient on their career path. Whether you’re interested in a certificate program, on-the-job training, apprenticeship, or an internship in STEM, NextGen will pair you with a team of dedicated experts in counseling, benefits, and peer support that will be behind you every step of the way. The NextGen Career Program is currently available in the following MBY area offices: Boston, Roxbury, Braintree, Lawrence, Lowell, Springfield, and Worcester.

 
Have you received any MBY services in the past (3) years (s)?





Please select one or more of the MBY services you are interested in applying for today.
























Check all that apply



Document Upload

If you have any supporting documentation listed below please upload them below. Providing some or all of the documents listed below as part of your application will assist in determining appropriate programs for you.

  • Resume
  • Any Medical or mental health documentation
  • Health Insurance Documentation
  • Education documentation (Individual Education Plan -IEP or any educational assessments/evaluations)
  • Personal Care Assistance documentation
  • Any documentation related to public benefits
  • And more!

Submit

MBY National Voter Registration Act of 1993 requires MBY to give you the opportunity to register to vote. Your decision to register to vote will NOT affect your eligibility for benefits. A mail-in voter registration form is enclosed in the middle of this welcome package. Or If you or any household member age 18 or over would like to register to vote, click on the link below (or copy/paste into your web browser) to learn how to register to vote. And if you have moved, changed your name, or want to update your political party affiliation, you need to update your voter registration.

Voter Registration | USAGov