self-referral

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HOME > CORE SERVICES > SELF-REFERRAL FORM

If you are interested in any of the DRC services and resources, please complete the self-referral form below and submit. An Independent Living Advocate will follow-up with you within three (3) business days. If you would like to speak to someone directly, you can call the main DRC office number at (712) 255-1065.

Please complete the following form as completely as possible.

Services requested?

Thank you, we will be in touch soon!