MENU

Problem Intake Form

 Are you a caregiver, individual or professional who needs help navigating the system? No matter how old your child or loved one is, The Arc of New Jersey Family Institute can assist you with questions or concerns. Please include as much information as you can when filling out the form. After you submit the information, a member of The Arc of New Jersey Family Institute staff will contact you. 

 To download a hard copy of the problem form please click HERE.

Consumer Information

/
/
Has the individual been found eligible for services through:
Is the individual Medicaid eligible?

Contact Person's Information

Is another agency/organization or attorney assisting you with this matter presently?

What Are You Having Difficulty With?

Please check the box that best fits your problem


I give permission for this information to be forwarded by The Arc of New Jersey to the Department of Children and Families (DCF), the Division of Developmental Disabilities (DDD) and/or NJ Division of Medical Assistance and Health Services (NJ Medicaid), or any other agency that may be able to help.