Skip to main content

The University of Alabama Wordmark

Students
Faculty & Staff
Alumni
Visitors
Apply
Give
Catalog
News
Events
Directory
Map

College of Community Health Sciences Toggle navigation

Close Menu
About
Education
Library
Research
Community Outreach
Alumni
- Legends
Tools
- Students
- Faculty & Staff
- Alumni
- Visitors
- A-Z Index
- Catalog
- News
- Events
- Directory
- Map

Home Legislation Who We Serve

Family Resources Self-Advocate Provider Resources Community Resources Educator Resources

Request for Training or Educational Talk Request for Event Attendance Request for Assistance

About Staff

If you are human, leave this field blank.

Request for Assistance

Name *

Date of Birth *

Sex *

Mailing Address *

Apt, suite, etc.

Country

City

State

Zip code

Phone Number *

Email *

Diagnosis *

Professional who gave the ADS diagnosis *

School District *

Are you receiving services from any of the following agencies? *

The Alabama Disabilities Advocacy Program (ADAP)

Child Care Assistance

Disability Benefits like SSI (Supplementary Security Income)

Early Intervention for your Infant or Toddler

Food stamps (SNAP)

Group Home

Head Start or Early Head Start

Housing Assistance

Medicaid

Phone or Fuel Assistance

TANF (Temporary Assistance for Needy Families)

Unemployment

Visiting Nurse or other Home Visiting like Healthy Families

Vocational Rehabilitation (VR)

WIC (Women, Infants, & Children Nutrition Program)

Other

The University of Alabama

Facebook
Twitter

Copyright © 2024 The University of Alabama | Disclaimer | Privacy | Accessibility | Intranet

This website uses cookies to collect information to improve your browsing experience. Please review our Privacy Statement for more information.