Intake Form – WCAG Compliant

Welcome! Thank you for considering Disability Rights South Dakota for your service needs related to a disability. To ensure we can assist you promptly, please complete and submit this form.

For further assistance or if you prefer not to fill out the form, you can reach our office at 1-800-658-4782 and request to speak with an Intake Specialist.

If you’re reaching out on behalf of someone else with a disability, such as a minor child, guardian, or authorized representative, please be prepared to have them contact us directly.

We appreciate your cooperation and look forward to supporting you. Please note that responses are provided in English.

Complete Your Intake Information

All fields marked with an asterisk (*) are required. This form collects information to help us determine if we can assist you with your legal matter. Your information is kept confidential.

Having trouble with this form?

If you experience accessibility barriers, cannot view or interact with this form, or prefer not to submit it online, we have other ways for you to complete your intake application:

Our Intake Team can help you complete your application by phone or email. There is no barrier to access—we are here to assist you.