Get Help

You can request assistance from Kentucky Protection & Advocacy by submitting the form below.

Someone will respond to your request within 3 business days.

Field GroupContact

Individual's Information

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First Name *PERSON WHO NEEDS ASSISTANCE

Last Name

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

County

Is this person deaf or hard of hearing?YesNo

If an interpreter is needed what language?

Person's disability

Date of Birth *

Please select the person needing assistance date of birth.

Living arrangementPlease provide person needing assistance current living arrangement.

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

Is this person a recipient of SSI/SSDI?YesNo

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

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

Phone number *

Email Address *

How should we contact you? *phoneemailtextotherPreferred method of contact

If other, enter method of contact preferred below.

GenderMaleFemalePrefer not to say

RaceAmerican Indian/Alaska NativeAsianBlack/African AmericanHispanic/LatinoNative Hawaiian/Other Pacific IslanderWhite

EthnicityHispanic/LatinoNot Hispanic/Latino

If completing on behalf of another person, what is your name: *

What is your relation to this person? *

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

How did you hear about P&A?

How can we help you?

Submit

Please do not fill in this field.