About You


We would appreciate any information you could provide us that would help us serve you better.
All information submitted will be recieved by Sarpy ARC and be kept confidential.
Thank your for your time!

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Home Phone: - -
Work Phone: - -
Your Email:

Are you a developmentally disabled person?
Yes
No

Are you the parent or sibling of a developmentally disabled person?
Yes
No

What is the age of the developmentally disabled person?


Do you reside in the Omaha metro area?
Yes
No

Are you moving to the Omaha metro area?
Yes
No


Are you a member of an organization that advocates for the developmentally disabled?
Yes
No

Would you be interested in becoming a member of an organization that advocates for the developmentally disabled?
Yes
No

Would you be interested in interacting with others in the Omaha metro area developmentally disabled community?
Yes
No

Would you be interested in learning more about pending State of Nebraska legislative actions that affect the developmentally disabled?
Yes
No

Which resources would you be interested in learing more about that are available in the Omaha metro area for developmentally disabled persons (check all that apply):
Child Care Services
Respite Care Services
Health Services
Transportation Services
Service Providers
Residential Opportunities
Special Education
Training
Employment Opportunities
Resources
Recreational and social organizations
Recreational and social activities
Special Olympics
Behavioral Sciences


If there is anything that you would like to tell us about yourself or your situation, or if you have any other comments, please submit here.

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