HIV/AIDS Application
How to Apply
You can conveniently apply via one of our secure online forms below. If you have any questions about the application process, please contact one of our Client Services representatives at 612-767-7333.
Ways to Apply
To Apply Via Mail or Fax
Download and print the pdf below to submit via mail or fax. Completed applications can be faxed to 612-872-0866 or mailed to our South Minneapolis building (c/o Client Services Department).
Please note: A signature from your medical provider, case manager, or social worker is required.
Securely Apply Online
You can conveniently apply via one of our secure online forms below. If you have any questions about the application process, please contact one of our Client Services associates at 612-767-7333.
UPDATE REGARDING ELIGIBILITY FOR RYAN WHITE SERVICES
Centralized Eligibility (CE): CE is a simplified enrollment and renewal process for Ryan White services, which allows all your Ryan White providers access to your Ryan White eligibility information through a secure database. This means that, instead of sending eligibility verifications to each individual provider (i.e. Open Arms), you can now apply for and renew your eligibility for Ryan White services once a year during your birthday month directly through DHS.
Questions regarding your eligibility for Ryan White services? Contact your designated eligibility specialist:
- Last names that begin with A – E: Kenya Lopez, 651-431-3928
- Last names that begin with F – LEA: Ashley Crosby, 651-431-6456
- Last names that begin with LEB – REE: Aimee Gunderson, 651-431-4224
- Last names that begin with REF – Z: Linda Atlas, 651-431-2408
What Happens Next?
After we receive your completed application form, a member of our staff will contact you to set up menu and delivery details.
Questions? If you have any questions about the application process, please contact one of our Client Services associates at 612-767-7333.
