Service and Information Request Form

If you are enrolled with the Developmental Disabilities Administration, fill out this form to request services and information, or contact your DDA case manager.

If you are enrolled with DDA, you can contact your case manager to request a service.
Not sure who your DDA case manager is? Call or visit your local DDA field office and ask them to look it up for you.

 

Call to request for the county you live in.Phone
Chelan, Douglas. Ferry, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens(800) 319-7116
Adams, Asotin, Benton, Columbia, Franklin, Garfield, Grant, Kittitas Klickitat, Walla Walla, Whitman, Yakima(866) 715-3646
Island, San Juan, Skagit, Snohomish, Whatcom(800) 567-5582
King(800) 974-4428
Kitsap, Pierce(800) 735-6740
Clallam, Clark, Cowlitz, Grays Harbor, Jefferson, Lewis, Mason, Pacific, Skamania, Thurston, Wahkiakum(800) 248-0949

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Or complete the form below and click "Submit."

 

Name of the person who will receive requested services
Name of person completing this form
Would you like an eligibility packet sent to you?
Mailing address – Street or P.O. Box, Zip
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