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ADANC Intake Form

ADANC’s Information and Referral Services Manager may be calling you to find out more information about your situation. Due to a disability, the staff member may be calling you with an operator using a system called Relay.

 

Please be patient with our staff and understand that we are doing our best to connect you with the requested services.

Contact Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

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Demographics
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(mm/dd/yyyy)
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Received Benefits and Services Requested
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Please select the benefits you are currently receiving
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Please select the service you need assistance with.
Information and Referral

Advocacy

Peer Support

Independent Living Skills Training

Some examples can include budgeting money, cooking, and household management skills.
Transition Services

Employment

Housing

Please call the resource below for the county you live in if you are experiencing homelessness. If you don’t see the county you live in listed, please call NC211 at 888-892-1162 to find an appropriate resource in your area.

Entry Point Durham984-287-8313

The House Wake Access Hub 919-443-0096

The Orange County Housing Helpline 919-245-2655

The Smithfield Rescue Mission 919-934-9257


The purpose of this question is to determine eligibility for the Targeted Unit Housing Program.

Youth Transition

Benefits Counseling