Emergency Needs Requests
If you have a disability that requires special assistance during an emergency, please fill out the form below.
This information will be kept confidential by state and local authorities.
This is NOT intended for residents who live in long-term care facilities or residential treatment facilities.
Please Note - A new form should be submitted each year in order to keep our records current.
Complete the Form Online
Click on the icon to the left to complete the emergency support requests.
Download and Mail in Form
Click on the icon to the left to download a fillable copy of the special needs registry form and mail to the ACSO Emergency Management Office.