Application

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3. Application

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Online Application for Help

Step 1 of 2

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If you prefer to apply over the phone, please call: (800) 662-9080.

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Are you contacting the DLC about yourself, or about someone else?(Required)

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Disability Note(Required)

Your Phone Number

Your Email(Required)

Your Zip Code(Required)

Your Date of Birth(Required)

Your Gender(Required)

Your Preferred Pronouns(Required)

Your Ethnicity(Required)

Name of the person you are contacting us about(Required)

First Last

Phone number for the person you are contacting us about

Email for the person you are contacting us about(Required)

Zip code for the person you are contacting us about(Required)

Date of birth of the person you are contacting us about(Required)

Gender of the person you are contacting us about(Required)

Preferred pronouns of the person you are contacting us about(Required)

Ethnicity of the person you are contacting us about(Required)

Has the person you are contacting us about served in the US Military?

What issue area are you needing assistance with?(Required)

Please explain your questions and/or concerns below(Required)

How did you learn about the DLC

Online Application for Help

Complete the application online or by phone

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Resources

Apply for Help

Application

Online Application for Help

Complete the application online or by phone

Disclaimer

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Automatic

Resources

Apply for Help