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641 E 112th Ave, Northglenn, CO 80233

info@arcadams.org

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- Staff & Board
- Financials
Child & Family Advocacy
- Request Child Advocacy
Adult Advocacy
- Request Adult Advocacy
- Self Advocacy
Systemic
Training
- Trainings by Guest Speakers
Events
Resources
Get Involved
ESPAÑOL

Home
About
- Staff & Board
- Financials
Child & Family Advocacy
- Request Child Advocacy
Adult Advocacy
- Request Adult Advocacy
- Self Advocacy
Systemic
Training
- Trainings by Guest Speakers
Events
Resources
Get Involved
ESPAÑOL

REQUEST CHILD ADVOCACY

“There needs to be a lot more emphasis on what a child can do instead of what he/she cannot do.” - Temple Grandin

*Completing this form does not guarantee advocacy services but we are committed to doing our best to provide information.*

ADVOCACY REQUEST FORM

Solicitud de Defensoría

Ready to request child advocacy?

If you are unsure about the child meeting the criteria, please click here.

What to Expect After Filling Out The Request Form?

Our Arc intake specialist will contact you to go over the following and discuss:

Qualifying for services
Assessing the situation
- Identify need of service
- Make recommendations
- Level of support
- General timeframe

OTHER CHILD & FAMILY TOPICS

CHILD & FAMILY ADVOCACY HOMEPAGE

SPECIAL EDUCATION

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First Name

Last Name

Email

641 E. 112th Ave. Northglenn, CO 80233

Phone: (303) 428-0310

Email: info@arcadams.org

© 2025 The Arc of Adams County *All Rights Reserved

Child & Family Advocacy Request Form

Please enable JavaScript in your browser to complete this form.

Please initial acknowledgment of the following:

We assist people with intellectual/developmental disabilities (IDD) which is an IQ or adaptive scores of 70 or below. *

An advocate will reach out to you to schedule a free consultation to discuss questions and concerns. *

You may need to provide necessary documents prior to the consultation appointment. (Ex: IEP/504, BIP, evaluations, etc.) *

Please note that a referral does not automatically result in direct advocacy services. *

Preferred language of the family/individual: *

Person Making the Request: *

Your Name *

First

Last

Relationship with Youth *

Name of Youth *

First

Last

Your email address *

Your phone number *

Age of Youth *

Gender of Youth *

Youth's Birthday (MM/DD/YYYY) *

Other *

What type of disability does the Youth have? Check all that apply. *

Intellectual Disability
Autism Spectrum Disorder
Physical Disability
Emotional/Behavioral Disability
Specific Learning Disability
Other
Unknown

Other *

Address Line 1 *

City *

Zipcode *

Address Line 2

State *

Youth's County of Residence *

School District *

School of Attendance *

Grade *

Issue/Need: *

Education
Disability/Benefit information
Lack of Services
Health/Safety
Behavior/Discipline
Basic Needs
Other:

Other: *

What kind of assistance are you needing? Check all that apply. *

Information and Resources
Technical Assistance
Direct Involvement

Is there a meeting scheduled regarding the issue/concern? *

Yes
No

Date, Time, Location of Meeting *

How do you want to be contacted to schedule the consultation? *

Phone
Email

When are you best available during the work week for the consultation? (Monday through Friday, 8:00 am to 5:00 pm)?

Day of the Week *

Time of Day *

How would you like to meet with the Advocate? *

In-person at the Arc office
Virtual Meeting
Phone call

Additional Information

Please initial acknowledgement of the following:

If possible, we prefer the family to contact us. *

Professionals must have permission from the guardian and provide a Release of Information to submit this request. *

We will not initiate contact with any guardian without their permission. *

Your name *

First

Last

Relationship with Youth *

Your phone number *

Your email address *

Name of Youth *

First

Last

Age of Youth *

Youth's Birthday *

What type of disability does the Youth have? Check all that apply. *

Intellectual Disability
Autism Spectrum Disorder
Physical Disability
Emotional/Behavioral Disability
Specific Learning Disability
Other
Unknown

Address of Youth *

Youth's County of Residence *

School District *

School of Attendance *

Grade *

Parent / Guardian Name *

First

Last

Phone *

Email *

Family’s Preferred Method of Contact *

Phone
Email

Issue/Need: *

Disability/Benefit information
Lack of Services
Health/Safety
Behavior/Discipline
Basic Needs
Other:

Other: *

What kind of assistance are you needing? Check all that apply. *

Information and Resources
Technical Assistance
Direct Involvement

Youth Address Phone

Is there a meeting scheduled regarding the issue/concern? *

No
Yes

Date, Time, Location of Meeting *

Additional Information

(Release of Information)

As the Parent/Guardian of *

I am permitting the information contained in the Child and Family Advocacy Request form to be shared with The Arc of Adams County. I understand that signing does not guarantee advocacy services. By signing this Release, I am giving The Arc of Adams County permission to contact me directly.

As a professional, you acknowledge that you have permission from the parent to make this referral? *

YES

Signature of Professional - (Typing your name here serves as a signature for the release of information.) *

Date *

Solicitud de Defensoría

Please enable JavaScript in your browser to complete this form.

Por favor, ponga sus iniciales para indicar que reconoce lo siguiente:

Brindamos asistencia a personas con discapacidades intelectuales y del desarrollo (IDD), lo cual se define como un coeficiente intelectual (CI) o puntajes de habilidades adaptativas de 70 o menos. *

Un defensor se comunicará con usted para programar una consulta gratuita y conversar sobre sus preguntas e inquietudes. *

Es posible que necesite proporcionar los documentos necesarios antes de la cita de consulta (por ejemplo: IEP/504, BIP, evaluaciones, etc.). *

Tenga en cuenta que los servicios de defensa pueden ser una opción si la persona cumple con los requisitos de admisión y elegibilidad. *

Persona que realiza la solicitud: *

Su nombre *

First

Last

Relación con el/la menor *

Su correo electrónico *

Su número de teléfono *

Nombre del/de la menor *

First

Last

Edad del/de la menor *

Fecha de nacimiento del/de la menor (MM/DD/AAAA) *

¿Qué tipo de discapacidad tiene el/la menor? Marque todas las que correspondan. *

Discapacidad intelectual
Autismo
Discapacidad física
Discapacidad emocional/conductual
Trastorno específico del aprendizaje
Otro
Desconocido

servicios día necesarios

Otro: *

Dirección del/de la menor *

Address Line 1

Address Line 2

City

State

Zip Code

Condado de residencia del/de la menor *

Distrito escolar *

Escuela a la que asiste *

Grado Escolar *

Problema/Necesidad: *

Escuela
Información sobre discapacidad/beneficios
Falta de servicios
Salud/Seguridad
Comportamiento/Disciplina
Necesidades básicas
Otro:

Otro: *

¿Qué tipo de asistencia necesita? Marque todas las que correspondan. *

Información y recursos
Asistencia técnica
Participación directa

¿Se ha programado una reunión respecto al problema/inquietud? *

Sí
No

Fecha, hora y lugar de la reunión *

¿Cómo desea ser contactado(a) para programar la consulta? *

¿Cuándo está disponible durante la semana laboral para la consulta? (De lunes a viernes, de 8:00 a.m. a 5:00 p.m.)

Día de la semana *

Hora del día *

¿Cómo le gustaría reunirse con el defensor? *

Información adicional

Fecha *

Adult Advocacy Referral Form

Please enable JavaScript in your browser to complete this form.

Please initial acknowledgment of the following:

We assist people with intellectual/developmental disabilities (IDD) which is an IQ or adaptive scores of 70 or below who live in Adams County *

Individual signed Guardian,

We will reach out to you to schedule a free consultation. *

You may need to provide necessary documents prior to the consultation appointment. *

Working with an advocate is time limited and specific depending on the advocacy goal. *

Please note that a referral does not automatically result in direct advocacy services. *

Name of Individual with IDD *

Gender *

Date of Birth *

Age *

Other: *

What type of disability does the individual have? Check all that apply. *

Intellectual Disability
Autism Spectrum Disorder
Physical Disability
Emotional/Behavioral Disability
Specific Learning Disability
Other
Unknown

Address *

City *

State *

Zipcode *

County of Residence *

Phone Number of Individual

Email of Individual *

Preferred Language of Individual *

Issue/Concern *

Is there already a meeting scheduled concerning this issue? *

If yes - date, time, and location?

If yes, with whom?

Is there a legal guardian? *

Yes
No
Unknown

If yes, provide name, relationship, and contact information. *

Your Name (If not Adult with IDD) *

Your Phone (If not Adult with IDD)

Your address (If not Adult with IDD) *

Your email (If not Adult with IDD) *

Relationship to Individual (If not the individual) *

Role *

Organization *

If not the Legal Guardian, do you have a signed Release of Information from the Adult to contact us? *

Current Services *

SLS Waiver
DD Waiver
Residential Program
Day Program
Transition Program with School District
Other
Unknown

Name of Agency *

Residential Manager *

Name of Day Program *

Day Program Manager *

School District *

Other Supports in the Individual's life:

Name *

Relationship *

Contact Information *

If this a health and safety issue, does it require reporting to the County Adult Protective Services (APS)? *

What you need to know about reporting to APS:

If you are a mandatory reporter and you witness or become aware that an at-risk adult with IDD has been or is in imminent risk for mistreatment (abuse, caregiver neglect, or exploitation), you must make a report to law enforcement within 24 hours.

What steps have been taken to resolve the situation?

Other information to share that is related to the need/issue:

Who is the preferred contact? (Name/relationship) *

Preferred method of contact: *

Best time to contact:

Question Form

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Name Email or

Email *

Phone *

Question or Message *

Custom Captcha *

What is 7+4?

Question Form

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Email *

Question Phone Email

Phone *

Question or Message *

Please fill out form as completely as possible. Put 'unknown' if you do not know the answer. Please allow up to 5 business days for a response.

Please enable JavaScript in your browser to complete this form.

Professional submit Guardian

Disclaimer: The Arc of Adams County assists individuals with documented Intellectual/Developmental Disabilities (IDD). Completing this form does not guarantee advocacy services but we are committed to doing our best to provide information. Advocacy services are voluntary support and not an emergency/entitlement service. If you are a professional making a referral, we prefer the Parent/Guardian to contact us directly. The Parent/ Guardian must sign the Release of Information (ROI) to submit this form. We will not initiate contact (cold call) to any Parent/Guardian without their permission. Due to the high number of requests, it may take up to 5 business days for a response. Please note: Advocates schedules may book out several weeks in advance. *

Acknowledge

Name of Youth *

First

Last

Age of Youth *

Their Birthday MM/DD/YYYY *

Their Address *

City *

State *

Zip Code *

Their County of Residence *

What type of disability does the child have? Check all that apply *

Intellectual Disability
Autism Spectrum Disorder
Physical Disability
Emotional/Behavioral Disability
Specific Learning Disability
Other
Unknown

Issue/Concern *

Is there a meeting already scheduled concerning this issue? *

Yes
No
Not sure

If yes, when?

If yes, with whom?

School District *

School *

Grade *

Name of Parent/Guardian *

Your Relationship to the Youth *

Phone Number of Parent/Guardian *

Email of Parent/Guardian *

Preferred Method of Contact *

Phone
Email

Please submit a release of information filled out by the parent/guardian. (Instructions and form are on the child & family advocacy request page) *

Drag & Drop Files, Choose Files to Upload

Please fill out the remaining questions if you are a professional making a referral. Name

First

Last

Role of Professional

Phone Number of Professional

Email of Professional

Are you interested in learning more about Arc of Adams County membership? *

Yes
No

In the meantime, learn more about membership by going to Arcadams.org/get-involved.

Child Form

Please enable JavaScript in your browser to complete this form.

Disclaimer: The Arc of Adams County assists individuals with documented Intellectual/Developmental Disabilities (IDD). Completing this form does not guarantee advocacy services but we are committed to doing our best to provide information. Advocacy services are voluntary support and not an emergency/entitlement service. If you are a professional making a referral, we prefer the Parent/Guardian to contact us directly. The Parent/ Guardian must sign the Release of Information (ROI) to submit this form. We will not initiate contact (cold call) to any Parent/Guardian without their permission. Due to the high number of requests, it may take up to 5 business days for a response. Please note: Advocates schedules may book out several weeks in advance. *

Acknowledge

Name of Youth *

First

Last

Age of Youth *

Their Birthday MM/DD/YYYY *

Their Address *

City *

State *

Zip Code *

Their County of Residence *

What type of disability does the child have? Check all that apply *

Intellectual Disability
Autism Spectrum Disorder
Physical Disability
Emotional/Behavioral Disability
Specific Learning Disability
Other
Unknown

Issue/Concern *

Is there a meeting already scheduled concerning this issue? *

Yes
No
Not sure

If yes, when?

If yes, with whom?

School District *

School *

Grade *

Name of Parent/Guardian *

Your Relationship to the Youth *

Phone Number of Parent/Guardian *

Email of Parent/Guardian *

Preferred Method of Contact *

Phone
Email

Please submit a release of information filled out by the parent/guardian. (Instructions and form are on the child & family advocacy request page) *

Drag & Drop Files, Choose Files to Upload

Please fill out the remaining questions if you are a professional making a referral. Name

First

Last

Role of Professional

Phone Number of Professional

Email of Professional

Name a when?

Are you interested in learning more about Arc of Adams County membership? *

Yes
No

In the meantime, learn more about membership by going to Arcadams.org/get-involved.

Child Advocacy Request

Child Advocacy Request Form

Child Advocacy Intake Request - Please fill out form as completely as possible. Put 'unknown' if you do not know the answer. Please allow up to 5 business days for a response.

Please enable JavaScript in your browser to complete this form.

Disclaimer: The Arc of Adams County assists individuals with documented Intellectual/Developmental Disabilities (IDD). Completing this form does not guarantee advocacy services but we are committed to doing our best to provide information. Advocacy services are voluntary support and not an emergency/entitlement service. If you are a professional making a referral, we prefer the Parent/Guardian to contact us directly. The Parent/ Guardian must sign the Release of Information (ROI) to submit this form. We will not initiate contact (cold call) to any Parent/Guardian without their permission. Due to the high number of requests, it may take up to 5 business days for a response. Please note: Advocates schedules may book out several weeks in advance. *

Acknowledge

Name of Youth *

First

Last

Age of Youth *

Their Birthday MM/DD/YYYY *

Their Address *

City *

State *

Zip Code *

Their County of Residence *

What type of disability does the child have? Check all that apply *

Intellectual Disability
Autism Spectrum Disorder
Physical Disability
Emotional/Behavioral Disability
Specific Learning Disability
Other
Unknown

Issue/Concern *

Is there a meeting already scheduled concerning this issue? *

Yes
No
Not sure

If yes, when?

If yes, with whom?

School District *

School *

Grade *

Name of Parent/Guardian *

Your Relationship to the Youth *

Phone Number of Parent/Guardian *

Email of Parent/Guardian *

Preferred Method of Contact *

Phone
Email

Please submit a release of information filled out by the parent/guardian. (Instructions and form are on the child & family advocacy request page) *

Drag & Drop Files, Choose Files to Upload

Please fill out the remaining questions if you are a professional making a referral. Name

First

Last

Role of Professional

Phone Number of Professional

Email of Professional

type of referral.

Are you interested in learning more about Arc of Adams County membership? *

Yes
No

In the meantime, learn more about membership by going to Arcadams.org/get-involved.

Adult Advocacy Interest Form

Please enable JavaScript in your browser to complete this form.

The Arc of Adams County assists individuals with documented Intellectual/Developmental Disabilities (IDD).

While we can’t guarantee that we’ll be able to provide assistance to everyone that completes this form, we’re committed to doing our best to help individuals and families in Adams County who are in need of support.

Due to the high number of requests, it may take up to 5 business days for a response. Please note: Advocates schedules may book out several weeks in advance.

Name of Individual *

First

Last

Age *

Address *

City *

State *

Zip Code *

County of Residence *

such of

Phone Number of Individual *

Email of Individual *

Issue/Concern *

Is there already a meeting scheduled concerning this issue? *

Yes
No
Not sure

If yes, when?

If yes, with whom?

Preferred Method of Contact *

Phone
Email

Your Name (If not the individual) *

Your phone number (If not the individual) *

Your email (If not the individual) *

Relationship to Individual (If not the individual) *

Are you interested in learning more about Arc of Adams County membership? *

Yes
No

Are you interested in receiving email updates from us such as monthly newsletters and current event information? *

Yes
No

Trainings offered by the Arc of Adams County staff, these trainings are scheduled by request only.

Self Advocacy Training
This a 4 week class ideal for self advocates to learn and refine their self-advocacy skills. Are you
new to using your self-advocacy skills? Want to increase your skills and confidence to speak up
for yourself? Want to get closer to reaching your goals? This class is for you! Ideal for
independent living programs, day programs, residential programs, advocacy groups. Groups of
10 or less recommended.

View PowerPoint here

For more information contact Joshua Wann, jwann@arcadams.org

Community/Victim Advocacy/First Responder Training
This is a 2 hour in-person/virtual training ideal for professionals wanting to learn more about working with
people with intellectual and developmental disabilities in the community. This training
promotes disability awareness, tips to improve interactions, increase positive outcomes, learn
about community resources, and get any questions asked and answered!

View First Responder PowerPoint here

View Autism Spectrum Disorder PowerPoint here

For more information contact Kari Easterly, keasterly@arcadams.org

Conflict Resolution
This is a 1.5 hour in person/virtual training is ideal for professional in the I/DD system who are struggling with
conflict management. Learn more about your own conflict management style, how to work
better in teams, and how to be more person centered in your approach. Ideal for groups of 10
or less.

View Conflict Resolution PowerPoint here

For more information, contact Kari Easterly at keasterly@arcadams.org

If I Were You and You were Me
This is a 2 hour in-person/virtual training specifically for direct care staff and focused on person centered approaches.
Learn more about how our attitudes and beliefs effect our own behavior, how our behavior
may be contributing to other’s behaviors, learn to be more person centered, and encourage
more positive experiences. Ideal for groups of 10 or less.
For More information, contact Keasterly@arcadams.org

Service and Supports for People with Intellectual and Developmental Disabilities
This is a training about Services and supports in the Developmental Disability System. This is an
hour training that is intended to be interactive so you can get all questions asked and
answered. Ideal for anyone but especially for transition aged individuals and parents.

View PowerPoint here

For More information, contact Keasterly@arcadams.org

Other Helpful Trainings on YouTube/Podcasts from Other Professionals
How to Become your Own PASA
Self Determination
Supported Decision Making

This a 4 week class ideal for self advocates to learn and refine their self-advocacy skills. Are you
new to using your self-advocacy skills? Want to increase your skills and confidence to speak up
for yourself? Want to get closer to reaching your goals? This class is for you! Ideal for
independent living programs, day programs, residential programs, advocacy groups. Groups of
10 or less recommended.

Contact Joshua Wann if interested (720) 634-6888 or jwann@arcadams.org

Solidarity Statement

The Arc in Adams County as well as all Arc Chapters in Colorado have always been and will continue to be civil and human rights organizations. We are pained and heartbroken by the acts of violence and racial injustice impacting our black and brown neighbors, friends and community. What happened to George Floyd, Ahmed Aubrey, and Breonna Taylor as well as the many others, is abhorrent and unacceptable. The Arc stands in solidarity with communities of color and victims of police brutality, those with disabilities and those without. We recognize the importance of listening to and hearing individuals who have experienced horrific injustices, and we commit ourselves to furthering our work as a civil and human rights organization. All people, without exception, should be able to access their community without fear. All people, without exception, should be able to engage in everyday activities without being policed. The disability rights movement is grounded on freedom and independence – just as racial equality, these principles are civil and human rights. We stand for the rights of all people to live, work, learn, love, and play without fear.

El Arc del Condado Adams, así como las otras sucursales del Arc en Colorado, siempre han sido y seguirán siendo organizaciones que defienden los derechos humanos y civiles de las personas. Estamos profundamente dolidos y desconsolados por los actos de violencia e injusticia racial que afectan a nuestros vecinos y amigos de la comunidad de personas de color. Lo que le sucedió a George Floyd, Ahmed Aubrey y Breonna Taylor, así como a muchos otros, es aborrecible e inaceptable. El Arc se solidariza con nuestras comunidades de color y con las víctimas de brutalidad policial, personas con discapacidades o no. Reconocemos la importancia de escuchar a las personas que han sufrido injusticias horribles, y nos comprometemos a continuar y expandir nuestro trabajo como organización civil y de derechos humanos. Todas las personas, sin excepción, deberían tener libre acceso a su comunidad sin sentir ningún temor. Todas las personas, sin excepción, deberían participar en sus actividades cotidianas sin sentirse que están siendo constantemente vigiladas. El movimiento por los derechos de las personas con discapacidades tiene como bases principales la libertad y la independencia; al igual que la igualdad racial, estos principios son derechos humanos y civiles. Defendemos los derechos de todas las personas a vivir, trabajar, aprender, amar y jugar sin miedo.

More about Kari...

Kari graduated from Gustavus Adolphus College with a Bachelor’s degree in Psychology, Anthropology and Sociology. Post college, she immediately started working in the field of intellectual and developmental disabilities and has worked in MN, IL, and South Dakota prior to coming to Colorado in 1997. She started working at the Arc of Adams County in 2000 as an Adult Advocate and moved into the role of Assistant Executive Director in 2021. As an Adult Advocate, she provided individual advocacy, worked closely with stakeholder groups regarding systemic advocacy, developed training to community members regarding disability awareness, and screened all adult advocacy requests. As the Assistant Executive Director, she provides oversight of the individual advocacy program, provides leadership to staff in their advocacy efforts, provides leadership regarding systemic advocacy provided by the advocacy team, and focuses on the agency’s community education and training goals. When asked what she loves most about working at the Arc of Adams County, she says it is without a doubt the Board’s and staff’s commitment to providing quality individual advocacy supports.

More about Paula...

Paula started her advocacy efforts with The Arc of Adams County in 1998. She has a bachelor’s degree in Special Education and Psychology and a master’s degree in City Planning both from the University of Texas. Her professional life has been a combination of social work, education and health care. Paula is grateful for the vast learning opportunities she has experienced working with families and other professionals. She values basic human and civil rights for all; no matter the gifts or challenges we each possess.

More about Jeannine...

Jeannine has been a Child and Family advocate with The Arc of Adams County since 1995. Her background is in Human Services and she has a bachelor’s degree from the University of Buffalo. Her passion comes from knowing that all people are of equal value and entitled to the same rights and opportunities. She often shares how grateful she is to have a career that is so aligned with her personal beliefs.

More about Linda S...

Since 1985 Linda has been the Executive Director at the Arc of Adams County. In the early 1960s she learned alongside peers with disabilities in elementary school. Linda’s Arc journey started as a young teenager in a Youth Arc. Volunteering at Summer Camp for children with IDD, being a Citizen Advocate for a man living in an institution and helping to remodel the first group home in her community. Those years created a lasting impact on her commitment to children and adults with intellectual and developmental disabilities. She has a BA in Social Work and her professional career prior to Arc Advocacy was case management and family support in public schools, institutions and community-based services.

Most of her work is systemic, policy and legislative advocacy. Connections with adults and families who are impacted by services or a lack of services is critical to driving policy. Any opportunity to assure that children and adults can live, learn, work, play and be accepted in their communities is worth the energy to get there.

For all people, regardless of their abilities or challenges, having a choice is essential to our wellbeing. Knowing there is someone who supports you to make decisions is important. The Arc offers the flexibility and strength to make a difference in people’s lives. Access to independent advocacy is a rare opportunity for many children and adults with IDD.

More about Kristian...

Kristian began working at The Arc of Adams County in 2017. She is a graduate from Georgia Southern University with a Bachelor of Science in Communications. The Arc has shed light on the injustices and inequalities individuals with Intellectual and Developmental Disabilities face daily. Although, she does not provide direct advocacy, she feels there is a vital role each member of society must play to ensure everyone can live an equal and opportune life. There is always room in our hearts for kindness when you realize everyone is deserving of happiness.

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