Advocacy Services Request Form

The Arc of the Central Mountains provides individual advocacy and support for children and adults with intellectual and developmental disabilities (I/DD) and their families in Eagle, Garfield, Lake, and Pitkin counties. Advocates can help individuals and families navigate educational, employment, Medicaid, Social Security, and disability-related services, understand their rights, and explore available resources and options. Advocacy services focus on guidance, collaboration, and problem-solving while respecting each individual's right to make their own decisions.

Person requesting services

I am requesting services for myself

I am requesting services for another person

Individual with Disability Information

Client First Name

Client Last Name

Client Phone Number

Client Age

Client Email

Address

Primary Contact Information

If you are requesting advocacy series on behalf of someone else, please put your contact information below:

Primary Contact First Name

Primary Contact Last Name

Primary Contact Phone Number

Primary Contact Email

Relationship to Person with a Disability

Primary Contact Address

Does the person you are requesting services for live with an intellectual or developmental disability (IDD)? If you are requesting services for yourself, do you live with IDD?

Yes

Unknown/Unsure

What other diagnoses or conditions should we be aware of?

Please describe why you are requesting advocacy services in as much detail as possible.

Select preferred method of contact

Phone

No Preference