Programs

Group Orientations

Every Wednesday at 9:30 am, Group Intake for all New Consumers to Disabled Resources Center, Inc.
We will have Group Intake in person and on Zoom if you cannot make it.

Please click the link below to join us every Wednesday @ 9:30 AM

JOIN ZOOM MEETING
HTTPS://US02WEB.ZOOM.US/J/89699378901

Meeting ID: 896 9937 8901
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+16699009128,89699378901# US (San Jose)
+13462487799,89699378901# US (Houston)

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+1 669 900 9128 US (San Jose)
+1 346 248 7799 US (Houston)
+1 253 215 8782 US (Tacoma)
+1 301 715 8592 US (Germantown)
+1 312 626 6799 US (Chicago)
+1 646 558 8656 US (New York)
Meeting ID: 896 9937 8901
Find your local number: https://us02web.zoom.us/u/k2V0h2iKx

Group Intake is a FREE information presentation available to all persons interested in becoming a consumer with Disabled Resources Center, Inc. (DRC). Come to learn what DRC services you may be eligible for. If you are a current consumer or have attended the group intake within the past 2 years there is no need to attend group intake, simply call in and set an appointment. Intake will last 45 minutes and when possible, an individual meeting will be scheduled immediately following the intake with appropriate staff member. Please refrain from wearing scented products to this and all activities at DRC.

Please fill out the new consumer intake form below:

Name*
First Last
Phone*
Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Birthday*
Month
Day
Year
Last 4 SSN*
Ethnicity:*
Gender Identify As:*
Sexual Orientation or Sexual Identity:*
Pronouns:*
Primary Language/Language(s) Used:*
Education Level:*
Living Situation:*
Veteran Status:*
Either spouse, legal partner, parent, or child served or is serving in the United States military?*
Consent to the ADRC to transmit their personal information to the Dept. of Veterans Affairs?*
Registered Voter?*
Accessible?*
Are you a CalFresh recipient?*
Do you have a caregiver?*
Do you have adequate access to food?*
In-Home Supportive Services Recipient?*
Are you or do you feel at risk for institutionalization?*
Does anyone at home make you uncomfortable, feel afraid, or threaten you?*
Are you kept isolated from friends or relatives?*
Do you feel someone is taking your money without approval?*
Please indicate service(s) requested by order of need (1 for primary, 2 for secondary, etc. List up to 4) with the dropdowns below:
Primary:*
Secondary:*
Third:*
Fourth:*
Please indicate primary (PD) and secondary (SD) disability where applicable with the dropdown below:
Primary:*
Secondary:*
How did you hear about us?*
Marital Status*
Are you the Head of Household?*
# in Household*
# of Children in household*
Emergency Information*
Income Source:
Employment/Private
SSI Benefits
SSDI Benefits
Cal-Fresh Program
VA Benefits
Pension/Retirement
SSA Retirement
State Disability
Welfare (Cash-Aids)
Worker's Compensation
Unemployment
Child Support
Family Support
No Income
Healthcare Insurance Provider*
Electronic Signature*
Sign and Date

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Group Orientations

Please fill out the new consumer intake form below:

Please indicate service(s) requested by order of need (1 for primary, 2 for secondary, etc. List up to 4) with the dropdowns below:

Please indicate primary (PD) and secondary (SD) disability where applicable with the dropdown below:

Income Source:

Contact

Quick Links

Stay Connected

Group Orientations

Please fill out the new consumer intake form below:

Please indicate service(s) requested by order of need (1 for primary, 2 for secondary, etc. List up to 4) with the dropdowns below:

Please indicate primary (PD) and secondary (SD) disability where applicable with the dropdown below:

Income Source:

Contact

Quick Links

Stay Connected

Follow us