Intake Form

Please fill out the intake form below.

First Name

Last Name

What is your disability?

Phone Number

E-Mail

Street Address

City

Zip Code

Is your issue about a particular agency, business or organization? If so, which one?

Please tell us about the situation.

News: A Night for Networking: Connecting Business & Talent Sep 02, 2010; MHAO Awarded Three Year Grant for Statewide Expansion of the Oregon Peer Employment Network Aug 31, 2010; DRO Advocate Encourages Rogue Valley's Deaf Community to Self-Advocate for New Technology Aug 30, 2010; The Accessibility in the Built Environment Subcommittee (ABE) is Looking for Volunteers Aug 26, 2010; Free Healthy Home Consultations for N/NE Portland Families Aug 24, 2010; More news…

Upcoming Events: Health Reform Community Meeting - BAKER CITY Baker County Library | 2400 Resort Street | Baker City, OR,
Sep 07, 2010; Health Reform Community Meeting - FLORENCE Florence Events Center | 715 Quince Street | Florence, OR,
Sep 09, 2010; Health Reform Community Meeting - PORTLAND University Place (Columbia Falls Room) | 310 SW Lincoln Street | Portland, OR,
Sep 13, 2010; Green Light: A Juried Exhibition of Emerging Artists with Disabilities Hamersly Library | Western Oregon University | Monmouth, OR,
Sep 15, 2010; Health Reform Community Meeting - MEDFORD Red Lion Inn (Crater Lake Room) | 200 N. Riverside Avenue | Medford, OR,
Sep 15, 2010; Previous events…; Upcoming events…

« September 2010 »