skip to main content
Alabama Disabilities Advocacy Program (ADAP)
  • Home
  • COVID-19 and People with Disabilities
    • Healthcare
    • Safety in Community / Facility
    • Special Education (K-12 and Post-Secondary)
    • Transportation and Housing
    • Voting
  • About Us
    • ADAP Services
    • Mission & Values
    • Goals & Priorities >
      • PAIMI Priorities FY21
    • ADAP Eligibility Requirements
    • Programming
    • ADAP Staff
    • Law Clerkship Opportunities
    • ADAP Disclaimer
    • ADAP Advisory Council >
      • PADD Advisory Council
      • PAIMI Advisory Council
    • ADAP Awards >
      • Jeff Ridgeway
      • Ricky Wyatt
  • Community Issues
    • Abuse/Neglect
    • Assistive Technology
    • Employment
    • Guardianship
    • HIV/AIDS
    • Mental Health
    • Social Security
    • Traumatic Brain Injury (TBI)
    • Veterans
    • Voting >
      • Vote for Access
  • Children's Issues
    • Bullying
    • Children's Mental Health
    • Foster Care
    • Juvenile Justice
    • Special Education
  • Assistance Needed
    • Resources >
      • Provider Intake Referral Form
      • ADAP Online Intake Form
      • ADAP General Contact Form
      • ADAP Publications
      • ADAP Federal Partners
      • Suggested Readings & Videos
    • Grievance Procedure
    • Grievance Form
    • Satisfaction Survey
    • Office Locations
    • Request Education / Training Presentation
    • Request Exhibit
    • Request a Publication
    • Special Education Bulk Book Order Form
    • Report Broken Links or Other Website Issues

ADAP Client Intake Form

 Please compete this form if you would like to schedule an appointment to speak with an intake advocate about a disability related issue. Complete as much information as possible. If you have difficulties using this form, please feel free to contact us via phone at 800-826-1675 or 205-348-4928.
*Required

NOTE: Filling out this form is not an indication of an attorney / client relationship and does not guarantee legal representation. All information is kept confidential.

    Information About the Person with a Disability

    Enter first name
    Enter middle name
    Enter last name
    Enter address
    Enter city
    Enter county
    Enter state
    Enter zip code
    Enter primary phone number
    Enter work phone number
    Enter an alternate phone number
    Enter email address
    Select living arrangement from options
    Enter "other" living arrangements if not available in drop-down options
    Enter birth month
    Enter date of birth
    Enter year of birth
    Click from options
    Enter ethnicity from drop-down options
    Enter race from drop-down options
    Enter from drop-down options
    Enter school district if this is an educational matter
    Enter the name of school if this i an educational matter
    Select any benefits or supports you may receive
    Select all disabilities that apply
    List any accommodations you may need with the intake process

    Primary Contact Information

    Enter first name
    Enter middle name
    Enter last name
    Select your relationship with the person with a disability from the drop-down options
    Specify if you would like to be on ADAP's mailing list
    Enter your email address
    Enter address
    Enter city
    Enter county
    Enter state
    Enter zip code
    Enter primary phone number
    Enter work phone number
    Enter an alternative phone number

    Reason for contacting ADAP

    Enter the problem that prompted you to contact ADAP
    Be specific about what you would like ADAP to do for you
    Enter any steps you have already taken to address this isse
Submit
Alabama Disabilities Advocacy Program (Main Office)
The University of Alabama
Box 870395
Tuscaloosa, Alabama 35487-0395
Physical Location: 624 Paul Bryant Drive
                             500 Martha Parham West
1-205-348-4928 (Phone)
1-205-348-3909 (Fax)
1-800-826-1675 (for clients - instate only)
e-mail: adap@adap.ua.edu
website: http://adap.ua.edu
ADAP 2020 | Equal Opportunity | Disclaimer | Privacy
 Tuscaloosa, AL 35487 | (205) 348-4928 |  ADAP Disclaimer
Website maintained by Alabama Disabilities Advocacy Program  and provided by The University of Alabama, Office of Information Technology
  • Home
  • COVID-19 and People with Disabilities
    • Healthcare
    • Safety in Community / Facility
    • Special Education (K-12 and Post-Secondary)
    • Transportation and Housing
    • Voting
  • About Us
    • ADAP Services
    • Mission & Values
    • Goals & Priorities >
      • PAIMI Priorities FY21
    • ADAP Eligibility Requirements
    • Programming
    • ADAP Staff
    • Law Clerkship Opportunities
    • ADAP Disclaimer
    • ADAP Advisory Council >
      • PADD Advisory Council
      • PAIMI Advisory Council
    • ADAP Awards >
      • Jeff Ridgeway
      • Ricky Wyatt
  • Community Issues
    • Abuse/Neglect
    • Assistive Technology
    • Employment
    • Guardianship
    • HIV/AIDS
    • Mental Health
    • Social Security
    • Traumatic Brain Injury (TBI)
    • Veterans
    • Voting >
      • Vote for Access
  • Children's Issues
    • Bullying
    • Children's Mental Health
    • Foster Care
    • Juvenile Justice
    • Special Education
  • Assistance Needed
    • Resources >
      • Provider Intake Referral Form
      • ADAP Online Intake Form
      • ADAP General Contact Form
      • ADAP Publications
      • ADAP Federal Partners
      • Suggested Readings & Videos
    • Grievance Procedure
    • Grievance Form
    • Satisfaction Survey
    • Office Locations
    • Request Education / Training Presentation
    • Request Exhibit
    • Request a Publication
    • Special Education Bulk Book Order Form
    • Report Broken Links or Other Website Issues