Penn Mar Human Services Forms

Forms

For your convenience, the LISS-related forms are listed here for easy access. These forms, presented in PDF format, can be viewed, downloaded and printed.

If you have questions/concerns, please reach out to our office: LISS@Penn-Mar.org or 877-282-8202

**As of today, the FY26 Guide is not yet available. Please refer to the FY25 Guide to LISS. When using it, be sure to apply the current fiscal year dates (July 1, 2025 – June 30, 2026) instead of those listed in the FY25 Guide.  Please also note that the limit for LISS funding is $1,000 this year.

Applicant and Family Guide – 2025

Applicant and Family Guide – 2025 – Spanish

Blank LISS Services and Eligibility Application

Blank LISS Services and Eligibility Application – Spanish

Independent Contractor Estimate of Services

Independent Contractor Agreement

Sample LISS Services and Eligibility Application

W-9 Form

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