IDignity Orlando Client Service Request Form

Please still fill out this request form so that we have record of your client's needs and can appropriately prepare for our appointment with them. 

Submitter Information

If your client is in:
This form is for new clients. If you have questions on your current case, please send an email to ccvolunteer@idignity.org. 


Advocate Contact Info

Advocate Name




Client Information

Client Name






MM/DD/YYYY


Please indicate state of birth if born in the US, or the country you were born in.
Documents You Need




Documents You Have
When meeting with IDignity, please bring whatever you have from the list below.


You can often tell by checking for a raised seal on the document.



Address Information



Follow-up

If none, please leave blank

If none, please leave blank

Please make sure contact information for either case manager or client is submitted, or we will not be able to contact you.

Please ensure you have enough phone minutes if you choose to do it over the phone; budget around 30-45 minutes.
IDignity is taking every precaution to provide a safe environment for our clients. Based on the results of this survey, IDignity will either reach out to you or the client to schedule a virtual or in-person interview. Thank you for your understanding.