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 logo
Alabama Disabilities Advocacy Program

PROVIDER INTAKE REFERRAL FORM

The Alabama Disabilities Advocacy Program (ADAP) provides FREE legal services to Alabamians with disabilities to protect their civil rights. We help with issues like special education, Medicaid, community integration, assistive technology, and ADA violations.

By completing and signing this intake referral form, you are:
  • Authorizing the provider listed below to share it with ADAP.
  • Authorizing ADAP to contact you so we can discuss your child’s disability-related legal rights concerns with you to see what, if any, help we can offer.
By completing and signing this intake referral form, you are NOT: 
  • Entering into an attorney-client relationship with ADAP. ADAP will not become your attorney unless and until we provide you with a written agreement that describes the scope of the services that we will provide.

    Provider Information

    Client Information

Submit
Provider: Please submit the completed form, print, sign and email it to adap@adap.ua.edu 
or print, sign and fax to ADAP at (205) 348-3909. Questions? Contact ADAP at (205) 348-4928
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