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Intake Form

Complete our online intake form and click Submit when you are finished.

DRP needs information related to the person with a disability to determine eligibility for services and for our statistical reporting purposes. All information provided is confidential.  Providing us with complete and detailed information about the person with the disability will allow us to respond to you more quickly and efficiently.

We provide an array of services to eligible individuals on issues that fall within our priorities and our case selection criteria.  DRP does not charge for services.  DRP cannot assist every individual who contacts us, but you should hear back from a DRP staff person within 5 business days of your request.

 

  • Information About The Person With Disability
    Check all that apply
  • Information About The Issue
  • Information About Person Submitting Request (If Different from Person with Disability)
  • Submitting the Online Form and requesting assistance does not establish an attorney-client relationship with DRP. Due to limited resources, DRP unfortunately cannot provide services to all persons with disabilities requesting assistance.
  • This field is for validation purposes and should be left unchanged.