Youth Empowerment Services Application Form (Fillable PDF)

Looking for a quick, paper‑less way to apply for Youth Empowerment Services (YES) in Texas? The official YES Waiver Verification Form (Form 2809) is now available as a fillable PDF on Formize. You can complete the entire application online, save a copy for your records, and submit it without ever printing a single page.

This page explains everything you need to know about the form, the sections you’ll encounter, and best practices to avoid common errors.

What Is the Youth Empowerment Application?

The Youth Empowerment Services (YES) Waiver Verification is used by local mental health authorities (LMHA) or local behavioral health authorities (LBHA) to document a participant’s choice to receive community‑based services instead of institutional care. It serves as the official application for eligibility and enrollment in the YES program.

How to Fill the Form Online

Instead of downloading the PDF and opening it in a separate editor, simply click the "Fill out this form" button on this page. The Formize PDF Filler app will load automatically, allowing you to type directly into each field.

Key Sections & Required Information

• Date & IDs: Enter the current date, CMBHS ID, and Medicaid ID.
• Participant Details: Full name, date of birth, and contact address.
• Legal Authorized Representative (LAR): Name and signature of the LAR.
• Choice of Service: Select the YES Waiver program or an alternative option.
• Signatures: Participant (or X mark), LAR, and LMHA/LBHA representative.

Common Mistakes to Avoid

• Leaving required fields blank – the form will not save until every mandatory field is completed.
• Using an illegible signature – type your name or use the built‑in signature tool for a clear, printable mark.
• Choosing the wrong enrollment type (Initial vs. Annual) – verify the purpose of your submission before selecting.
• Entering outdated ID numbers – double‑check your CMBHS and Medicaid numbers with your provider.

Download & Print Options

If you still prefer a hard copy, you can download the completed PDF after filling it out and print it using any standard printer. The file remains fully editable until you finalize and save the document.

Ready to start? Click the button below, fill out the form in seconds, and take the next step toward youth empowerment.