Intake Form

You can begin DRNJ's intake process by completing the form below. Any inquiry or request for assistance must have a completed Intake Form before it can be processed for review. After you submit your request, a member of DRNJ's intake staff should attempt to contact you within 5 days.

(client)

Is another agency/organization or attorney assisting you with this matter presently?

Referred by: (must provide for DVRS cases)

Please complete the next section ONLY if you have a special education issue, otherwise, leave blank.

This form is not compatible with all versions of Internet Explorer. If you experience technical issues submitting this online form, please click here and submit as an email attachment to advocate@drnj.org.

NOTE: You must save the attachment before you submit or your information will not transmit.

Any inquiry or request for assistance must have a completed Intake Form before it can be processed for review


 

 

 

 

 

Disability Rights New Jersey
210 S Broad Street, 3rd Floor
Trenton, New Jersey 08608
1.800.922.7233 (in NJ only) � 1.609.292.9742 (Voice)
1.609.777.0187 (Fax) � 1.609.633.7106 (TTY)
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