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Need Our Assistance?

You may complete and submit this form to request services for an issue directly related to a disability. A current phone number is required so that an advocate can contact you for further information that will be used to determine the level of service our agency can offer you.

You may also contact us at 800-422-6691 to either speak with an advocate between 8 am and 12 PM, Monday through Friday, or to make an appointment with one of our advocates. 

If you are contacting Disability Rights Nebraska about an individual with a disability other than yourself, we will ask you to have the individual contact us directly, unless you are an authorized representative of the individual, i.e. the parent of a minor child, the individual's guardian, etc.

If you are requesting assistance for another individual, please provide the following information for that individual.
Disability (check all that apply)
Do you receive:
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