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Disabilities Program Referral Form

Disabilities Program Referral Form

Are you eligible for Developmental Disabilities services?

Icon of person on phone headset

Main Number
503-655-8640

Intake and Eligibility
503-557-2824

Before a person can receive services through the Developmental Disabilities program, they must complete an intake process and be determined eligible. To refer yourself or someone else, please complete this online referral form, call, or email us.

Applicant Information

You don’t qualify for this program because you selected a state of residence besides Oregon. This program is only offered in Oregon.


Intellectual or Other Developmental Disability Diagnosis (Optional - check all that apply)

Referral Source

Who should we contact to follow up on this referral or to start the intake process?

Is this person the legal guardian?

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