Divison of Disability Services

Contact Us Form

Pursuant to the Open Public Records Act (OPRA), email content is a matter of public record. Email should not be utilized for sending confidential information. Contact information is made available to other state agencies upon request. If additional information is needed, we will contact you.

This form and the associated email account are monitored only during regular business hours, excluding holidays. Do not use this form or email account to request emergency assistance or crisis intervention. If you are experiencing a crisis or medical emergency, seek immediate assistance rather than waiting for a response.

Fields marked with an asterisk (*) are required.

Select Language Choose the language you want to read this form in. Value is not selected

Note: For a faster response, please type your information and questions below in English.

Personal Information

First Name:

MI: Middle initial, if you have one.

Last Name:

Address Lookup

Address Line 1: Street number and name, or PO Box.

Address Line 2: Apartment, suite, unit or floor, if any.

City:

State: Value is not selected

Zip: 5-digit ZIP code, for example 08625.

Country: Value is not selected

Contact Information

Phone: Phone number must follow the format: (000) 000-0000.

Email: We’ll send a confirmation of your message to this address.

Email Confirmation: Enter the same email address again.

Email Validation

Contact Us

Subject: A short title for your question or concern (up to 75 characters).

Your Comment: Please provide more details regarding your concern. This information will help our staff assist with your concern (up to 5000 characters).

Sign to verify that the information you have provided is correct.

Signature:

Your session has timed out.

Click here to access the application.

DDS Contact Form

Divison of Disability Services

Contact Us Form

Personal Information

Contact Information

Contact Us