Personal Care Attendant Registry: Application | Executive Office of Health and Human Services

Official State of Rhode Island website

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The Executive Office of Health and Human Services State of Rhode Island

Applicant Information

First name

Last name

Confirm Age

I certify that I am 18 years of age or older

Gender

Male

Female

Address

Address 2

City/Town

State

ZIP/Postal Code

Country

Your Email Address

Your Phone Number

Best time to contact you

Contact Preference

Phone

Text

List languages in which you are fluent

List languages in which you are fluent
Language

How did you hear about the PCA opportunity?