Online Intake Form

**From December 25, 2019 through January 1, 2020, we will not be able to process any online or voicemail message requests for our help. If you have any upcoming deadlines or need immediate assistance with your legal matter, please contact Legal Aid of North Carolina at 866-219-5262 to apply for their assistance and/or the North Carolina Bar Association’s Lawyer Referral Service at 800-662-7660. We will return any voicemail or email messages requesting our help on January 2, 2020.**

Fill out the form below to apply for help with our office.  Please be as complete as possible, and include any important supporting documents.  You may save and continue this form later at any point.

If you need help filling out the form, would like an accommodation, or have questions, then please give us a call!  We’re happy to help!

For a more detailed explanation of our services, please see our intake chart.

If you have any questions, please call our office at 919-856-2195 or email us at intake@disabilityrightsnc.org