Become a Chapter - Contact Us | The Arc

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• Organization Name*

• Date* MM slash DD slash YYYY

• State*Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsin

• Primary Contact Person *

• First Name*

• Last Name*

• Primary Contact Title

• Phone Number*

• Email Address*

I am an individual interested in learning more about establishing a chapter in my community

• Do you have experience with a chapter of The Arc? (check all that apply)
• Member
• Volunteer
• Board member
• Staff
• Funder
• Other (specify):

• Why do you want to establish a chapter of The Arc in your community?
• I’m a parent interested in services for my child
• I lived in a community with a chapter and have relocated to a community without a chapter
• People with intellectual and/or developmental disabilities and their families are underserved or dissatisfied with their services
• My community doesn’t have enough advocates helping individuals and their families
• Other (specify):

• What do you want to achieve by establishing a chapter of The Arc? (check all that apply)
• Additional support for individuals and families
• Additional advocacy for individuals and families
• Quality services
• Social/recreation opportunities
• Advocating with legislators and funders
• Other (specify):

I am part of a group of people interested in learning more about establishing a chapter in my community

• Does anyone in your group have experience with a chapter of The Arc? (check all that apply)
• Member
• Volunteer
• Board member
• Staff
• Funder
• Other (specify):

• Why does your group want to establish a chapter of The Arc in your community?
• We’re parents interested in services for our children
• Some of us lived in a community with a chapter and have relocated to a community without a chapter
• People with intellectual and/or developmental disabilities and their families are underserved or dissatisfied with their services
• My community doesn’t have enough advocates helping individuals and their families
• Other (specify):

• What do you want to achieve by establishing a chapter of The Arc? (check all that apply)
• Additional support for individuals and families
• Additional advocacy for individuals and families
• Quality services
• Social/recreation opportunities
• Advocating with legislators and funders
• Other (specify):

We are a private nonprofit organization recognized by the IRS with approval from our state to receive charitable donations

• What year was your organization established?

• What is your organization’s annual revenue?

• How many professional staff do you employ?

• What is your geographic service area (cities, counties)?

• Has your organization ever been affiliated with The Arc?

• What services do you currently offer? (check all that apply)
• Access, Equity, and Inclusion
• Advocacy
• Aging
• Criminal Justice
• Education
• Employment
• Finance
• Guardianship/Conservatorship
• Health
• Housing/Residential/Supported Living
• Inclusion/Life in the Community
• Individual and Family Supports
• Research
• Respite (In-Home, Center-Based, Overnight, Emergency, etc.)
• Sexuality Education
• Social/Recreation
• Spirituality/Religion
• Technology
• Transportation

• Why does your organization want to affiliate with The Arc? (check all that apply):
• We’re interested in joining a national network
• The Arc’s brand is recognized and valued in our community
• We’re interested in becoming more involved in state and federal public policy advocacy
• We believe The Arc’s resources will enhance our organization
• People in our organization have had positive experiences with The Arc
• Other (specify)