Intake Request Form

Education
Disability Rights Oregon's education attorney is focusing on the issue of districts that shorten the school days of children with disabilities because of their behavior. For that reason, DRO cannot promise responses to requests for assistance about other special education issues. In the meantime, a great deal of useful information about a wide variety of special education issues is available on DRO's Know Your Rights: Children's Rights and Special Education page and specifically DRO’s publication Special Education: A Guide for Parents and Advocates.

School districts may shorten your child’s school day only if they meet specific requirements. If your child has been subjected to shortened school days for an extended period of time because of behavior, please go to our Request Help for Shortened Schooldays page, and complete that form there.
Please describe the education issue for which you seek assistance.

Guardianship
Did you receive a guardianship petition or are you under guardianship?

YesNoUnknown
Do you want to know about your legal rights as a person under guardianship?

YesNoUnknown
Please describe the concerns you have about your guardianship.

Medical Care
If you feel you were mistreated by a hospital, healthcare facility, doctor, or another mental health professional, you may want to file a complaint about your experience. If you want to sue a hospital or doctor for money, DRO is unable to represent or file a lawsuit for you. You can review options for filing complaints and grievances against healthcare providers.
Please select the medical care issue for which you seek assistance (select all that apply):

Mistreatment by a medical facilityLack of accommodations in a medical facilityDeprivation of rights or liberties in a medical facilityDenial of treatment from a medical facilityDischarge planning from a medical facilityOther
Please describe the issue for which you seek assistance.

0/250
How do you think we may be able to assist you?

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Mental Health
If you feel you were mistreated by a hospital, healthcare facility, doctor, or another mental health professional, you may want to file a complaint about your experience. If you want to sue a hospital or doctor for money, DRO is unable to represent or file a lawsuit for you. You can review options for filing complaints and grievances against healthcare providers.
Please select the mental health related issue for which you seek assistance (select all that apply):*

Treatment by a healthcare providerTreatment by a hospitalTreatment by the criminal justice system (police/court/jail)Other
If your inquiry is regarding a hospital, which hospital?
If your inquiry is regarding the criminal justice system, do you have an open criminal case?

YesNo
If you selected "Yes" above, what is the case number?
Please describe the issue for which you seek assistance.

0/250
How do you think we may be able to assist you?

0/250
Have you contacted Disability Rights Oregon in the past?

YesNoI don't know

Physical Accessibility
Please select where you experienced the accessibility issue for which you seek assistance:

to sidewalks, roads, curb rampsto or within a government building (city hall, public library)to or within a place of public accommodation (grocery store, pharmacy, movie theater)a website or other electronic resources
Please describe the issue for which you seek assistance.

0/250
How do you think we may be able to assist you?

0/250

Residential Facilities
Please select the residential facility issue for which you seek assistance (select all that apply):

Mistreatment in a residential facilityLack of accommodations in a residential facilityDeprivation of rights or liberties in a residential facilityEviction from a residential facilityOther
Please describe the issue for which you seek assistance.

0/250
How do you think we may be able to assist you?

0/250

Social Security Overpayment
Please select the source of concern (select all that apply):

Work-Related OverpaymentsSocial security benefits cessation based on SGA (not overpayment)Benefits questions/work incentives (Not SSA benefits cessation or work-related overpayment)Insufficient/improper benefits planning
Did you receive a notice from the Social Security Administration of a work-related overpayment?

YesNo
If you received an overpayment notice, when did you receive the notice?

MonthDayYear
If you received an overpayment notice, have you filed a request for reconsideration or a request for waiver with the Social Security Administration?

YesNo
Please describe the issue for which you seek assistance.

0/250
How do you think we may be able to assist you?

0/250

Other

Due to the current number of cases currently unresolved, we are not accepting any new requests for services related to Assistive Technology (AT), Employment, Housing, Physical Accessibility, or Vocational Rehabilitation (VR). If you need assistance with AT, Employment, Housing, Physical Accessibility, or VR, please check back in 21 days.
Please describe the issue for which you seek assistance.

0/250
How do you think we may be able to assist you?

0/250

Information about the issue