Get Started with CdE

Community Support & Empowerment Intake Form

Welcome to the Center for Disability Empowerment (CDE). You are the expert on your own life. This form helps us understand your goals so we can ignite your journey toward independence and leadership. All information is kept confidential.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Section I: Contact Information

Full Name*
Address
Best Way to Reach You*
Would you like to receive CdE email updates?*

Section II: How Can We Help You Thrive?

I would like support with...*
Please check all areas where you would like to ignite your power and access.

Section III: About You

CDE serves individuals of any age, any disability type, and any income level at NO COST to residents of Central Ohio. No formal documentation or diagnosis is required.
Age Range*

Section IV: Our Commitment to You

  • Nothing About Us Without Us: You will lead the way in shaping your own life.
  • Lived Experience Matters: Our team values your lived experience as essential expertise.
  • Free of Charge: All support and training is provided at no cost, always.
  • Confidential: Your information stays private. Sharing is always your choice.