Registration for IN PERSON workshop- Applying for Soc. Security Disability Programs

Registration Form for the (In-Person) "Applying for Security Disability Programs" Workshop

This monthly informational workshop is located at the office of Taconic Resources for Independence, Inc. 82 Washington St. Suite 214, Poughkeepsie NY 12601
For any accommodations, please submit this request form two weeks before the date you want to attend.

If there are any changes to the workshop, including cancellation, we will contact you via email.

*If you are having difficulty with this registration form, call the front desk and we will go through the questions with you.

If you are not able to attend a workshop you’ve signed up for, please let us know as soon as possible. Please call our office at 845-452-3913 ext. 119, providing your full name and the workshop date you registered for.
If you are feeling sick, please call to cancel.

Click on the blue NEXT button below to complete the Registration Form.

I would like to attend _________________ (select the date and time below)*
Double check the date you selected is correct. *** indicates that the date has been rescheduled
Today's Date*

MonthDayYear
It's automatic.
I am attending as a...*
Every person attending must register themselves.
Your Name*

First NameLast Name
What are your pronouns?
she/her he/his they/them etc..
Best Phone number to reach you:*
During the hours 9am-5pm, Monday through Friday
Ext.
If you are a Human Services Professional
What type of phone is this?*
Your Email address*
double check the spelling of your email
What is the best method to contact you*
Phone, email, or both
Would like to be emailed information about other important TRI events, services, and programs? Your contact information will always be kept confidential.

Yes pleaseNo thank youI'm already signed up
Name of AgencyBusiness you work for
If you are attending as a Human Services Professional
Your Mailing Address (Apt or House # & Street name)*

Street Address Line 2

Street Address Line 2

CityState

Zip
What disability program are you planning to apply for?*
Have you previously applied for SSISSDI? If yes when?*
No or Yes (with date)
What is the nature of your disability? Cognitive-learning disability, Mental Health related, Physical, Hearing, Vision...?*
Diagnosis is NOT needed
What accommodation(s) do you need? Examples: Large Print - what size font? American Sign Language interpreter... We need to know 2 weeks in advance.
If you're having difficulty with this form, call the front desk: 845-452-3913
Tell us! How did you find out about Taconic Resources for Independence Inc?*
examples: Google, Facebook, Instagram, Email, friend, Name of agency who referred you.
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Registration Form for the (In-Person) "Applying for Security Disability Programs" Workshop