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Disability Resource Partners – Intake Form

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What best describes you?

Parent or caregiver of a person with a disability

Individual with a disability

Provider or professional

Advocate or nonprofit partner

Other (please specify)

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What challenges are you currently facing?

Navigating Medicaid / waiver programs

Housing or accessibility modifications

Employment or resume support

Applying for SSI or SSDI

Behavioral, medical, or education advocacy

Finding trustworthy local resources

Caregiver burnout / lack of support

Other (please specify)

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How do you prefer to receive information?

Text and checklists

Video tutorials

Audio guides or podcasts

One-on-one help

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Would you like to join our beta test team?

A

Yes, keep me updated!

B

No thanks