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Intake Form


You can begin Disability Rights NJ’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 Disability Rights NJ’s intake staff should attempt to contact you within 5 days.

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

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