TX HHS Form 1351. Request to Withdraw from the CLASS Application Process

The TX HHS Form 1351, Request to Withdraw from the CLASS Application Process, is a practical tool for individuals who have received information about the Community Living Assistance and Support Services (CLASS) Program. This program provides individualized services to persons with related conditions living in the community.

This form helps solve the problem of withdrawing from the CLASS application process when an individual's needs are being met through other programs or services. The form is typically used by individuals who have received information about the CLASS Program and no longer wish to participate. Key features of this form include a checkbox for selecting the reason why the individual wants to withdraw, as well as a comments section for providing additional information.

By completing this form, an individual can formally decline the offer to participate in the CLASS Program at this time and request to be considered for enrollment in the future. The form also includes space for the applicant's signature and date, as well as that of their Case Management Agency Representative. Key points to note include:

• Reasons for withdrawing from the CLASS application process
• Comments section for providing additional information
• Signature and date requirements