Household Employer Registration

The SCRC Training Website will be down for maintenance this Thursday, February 15, 2018 between 1 PM and 2 PM EST. We apologize for any inconvenience.

Please fill out the form below to register for the Household Employer training module. Once you have registered, SCRC will be in touch with information about how to access the specialized Household Employer Training Module.

Please complete all fields so that we will be able to communicate effectively with you and your case manager.

Note: The registration form identifies unique registrations based on an individuals email address. You will need to use an email address that isn’t used by someone else in order for your registration form to be completed.

If you do not have an email, please contact SC Respite Coalition prior to completing your registration. You can contact us at 803.935.5027 and choose extension 3 for Ellen Hinsch.

Household Employer Information
The Household Employer is the person that is legally responsible for the consumer.
Melissa Ellington*
First Middle Initial Last
Household Employer Home Address*
316 Winding Wood Circle Address Line 2 Blythewood SC 29016
Mailing Address?
- Mailing Address Same as Above
Household Employer Mailing Address
Street Address Address Line 2 City State ZIP / Postal Code
How would you like for SCRC to contact you?*
email address: mesellingtonph@gmail.com 803-48-5634/3866
Household Employer Primary Phone Number*
This will be the number we call first. 803-348-5634/3866
803-348-5634*
803-348-3866
May we Text you at this number?*
Household Employer Email*
mesellingtonph@gmail.com mesellingtonph@gmail.com

SCRC communicates primarily by email. Please use your own email address and provide one that you check regularly. Please Note: The database will use this email as an identifier for you. Please do not use someone else's email.
Blythewood*
Consumer Information
The Consumer is the person that is approved to receive waiver services.
What is the Consumer's Name?*
David Middle Initial Ellington
08/06/2009
MM slash DD slash YYYY
yes*
Case Manager
The Case Manager is the person that coordinates the waiver services for the consumer.
Annemarie Telleri*
First Last
803-748-5020 ext 6*
annemarie@arcsc.org*
Respite Provider Information
The Respite Provider is the person you are hiring to provide the respite services.
yes*
- Yes
- No
Sue Swick*
First Last
sswick@heathwood.org*
Respite Care Provider Address*
316 Winding Wood Circle Address Line 2 Blythewood SC 29016
If you have chosen more than one respite caregiver, please include their information in the fields below.
- I have more than one chosen caregiver
If you have chosen more than one respite caregiver, please include their information in the fields below.
Respite Care Provider Name
First Last
Respite Care Provider Address
Street Address Address Line 2 City State ZIP / Postal Code
Respite Care Provider Email
Respite Care Provider Name
First Last
Respite Care Provider Address
Street Address Address Line 2 City State ZIP / Postal Code
Respite Care Provider Email
Please choose a Username and Password
Username*
(alpha - numeric characters, dashes, and underscores only)
Password*
Enter Password Confirm Password
Number

Household Employer Registration

Household Employer Information

Consumer Information

Case Manager

Respite Provider Information

Please choose a Username and Password