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Support Request Form
Inclusion Saskatchewan supports people with intellectual disabilities. Please fill out all information to the best of your ability.
Additional Information for Individual Requiring Support
Birthdate:
Does the person identify as having an intellectual disability?
*
Yes
No
(Optional) What intellectual disability does the person experience?
Reason for support request:
Preferred method of contact
Phone call
Text Message
Email
Video call
General Information
If you are submitting this form on behalf of someone else, please provide your information below
Name
Phone Number
Email Address
Relationship to the person:
Have you notified the person that you are submitting this form on their behalf?
Yes
No
Additional Contact
If there is a support person that we should contact regarding this request, please provide their information here. This could be a direct support worker, family member, professional support, etc.
Name
Phone Number
Email Address
Relationship to person requiring support:
____________________________________________________________
I understand that submitting this form does not guarantee support from Inclusion Saskatchewan.
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Yes
Additional Information for Individual Requiring Support
Birthdate:
Does the person identify as having an intellectual disability?
(Optional) What intellectual disability does the person experience?
Reason for support request:
Preferred method of contact
General Information
Name
Phone Number
Email Address
Relationship to the person:
Have you notified the person that you are submitting this form on their behalf?
Additional Contact
Name
Phone Number
Email Address
Relationship to person requiring support:
____________________________________________________________
I understand that submitting this form does not guarantee support from Inclusion Saskatchewan.
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