Request Adult Advocacy | The Arc of Pueblo

Areas of Assistance

What to Expect After Filling Out The Request Form?

Our Arc intake specialist will contact you to go over the following and discuss:

Request Adult Advocacy Form

Your Information

First Name

Last Name

Relationship to Individual

Individual's Information

First Name

Last Name

Age

Phone

Issue/Concern

Is there already a meeting scheduled concerning this issue?

If yes, when?

If yes, with whom?

Professional Adult Advocacy Interest Form

Your Information

Name

Relationship to Individual

Phone

Individual's Information

First Name

Last Name

Age

Phone

Individual's Address

Individual's Preferred Method of Contact

Best time/place to reach individual

Guardian/Family Contact

Name

Phone

Best time to call if need be

Do you have a release to call us?

Note: A Release is necessary to process intake interest form.

Does this person have a I/DD?

Level of Urgency HIGH MEDIUM LOW

Is this person homeless? YES NO UNSURE

Is this a health/safety/neglect issue?

If so, did it require a mandatory report and did you report it?

Reason you are referring: (advocacy issue)

Current Services (i.e., School/Grade, SLS, Comprehensive Services, Community Resources):

Involved Parties (i.e., teacher, Coordinators, Service Agencies):

Other Pertinent Information?

THIS PORTION OF THE FORM IS TO BE FILLED OUT BY THE INDIVIDUAL/GUARDIAN.

Disclaimer:

The Arc of Pueblo assists individuals with documented Intellectual/Developmental Disabilities (IDD). Completing this form does not guarantee advocacy services, but we are committed to doing our best to provide information. Advocacy services are voluntary support and not an emergency/entitlement service. If you are a professional making a referral, we prefer the Individual/Guardian to contact us directly.

Release of Information

I am permitting the information contained in the Adult Advocacy Request form to be shared with The Arc of Pueblo. I understand that signing does not guarantee advocacy services. By signing this Release, I am giving The Arc of Pueblo permission to contact me directly.