Disability Resource Center

Self-Referral Form

If you are interested in any of the DRC services and resources, please complete the self-referral form below and submit. An Independent Living Advocate will follow-up with you within three (3) business days. If you would like to speak to someone directly, you can call the main DRC office number at 706-778-5355.

Please complete the following form as completely as possible.

  • How did you hear about us?
  • If you are under 18, please provide your parent or guardian’s name
  • Services Requested
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