Kentucky protection & advocacy

toll Free

1-800-372-2988

kentucky PROTECTION & ADVOCACY

What is your relationship to the person requesting assistance?

Person's disability:

Email address: *

County

5 MILL CREEK PARK

FRANKFORT KY 40601 US

Phone: 1.502-564-2967

Toll Free: 1.800-372-2988

Fax: 1.502-695-6764

email: KYPandAinquiry@gmail.com

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Date of birth:

If this person is over 18, does he/she have a guardian?

Yes

Name of person who needs assistance *

Our Office

If the reason you are making contact involves a school issue, provide the name of the school

Address, City, State, Zip

If you are calling on behalf of someone else, please complete the following: Your Name:

How did you hear about P&A

If this person a recipient of SSI/SSDI

Yes

Telephone number: *

If this person is over 18, is he/she registered to vote?

Yes

Race: Gender:

Living Arrangement:

INTAKE FORM (someone will respond within 3 business days)

Preferred method of contact: telephone, email, text, Video Relay Service (VRS)

Address, City, Zip

Telephone Number

Is this person deaf or hard of hearing?

If an interpreter is needed what language:

Explain the reason you are contacting Protection & Advocacy

If this person is over 18, is he/she a veteran?

Yes