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Alliance of Disability Advocates Referral Form

Please fill out the following information so that we can better serve you or the person you are referring. If you have any questions, please feel free to call our office at (919) 833-1117 and ask to talk to the Information & Referral Services Manager.


Due to the unprecedented impact of the pandemic, Alliance of Disability Advocates has received more requests for assistance than our current capacity allows. As a result, we have created a waiting list.  Please know that each request for assistance is carefully reviewed and weighted in terms of need.




Please select the role of the person completing the referral form.
Please select "Yes" if the person you are referring is part of the TCLI program.
Please select "Yes" if you work for an LME/MCO and "No" if you work for another type of organization.
Error: TCL Referrals from LME/MCOs only

Referrals for TCL services though the Center for Independent Living must come from an LME/MCO. Please contact the LME/MCO that the consumer works with about making the referral.

Please select your Organization

If you have the name or contact information of the person who referred you, please include that here.

Referring Agency


Referring Individual

Name of person completing form on behalf of consumer