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If you are applying for someone else, be sure to use the person who would like to receive services name in the application

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What Best Describes Your Role

Parent/Guardian

Caseworker

Friend or Family Member

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First Name of Person Seeking Services

Last Name of Person Seeking Services

Email of Best Contact Person

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Address of Person Seeking Services

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Birthday of Person Seeking Services * required

What do you, or the person seeking services, need help with?

If you feel comfortable, please disclose the nature of your disability.

Thanks for applying for services! An RRCI team member will reach out soon!

Call RRCI at 435-673-7501

Red Rock Center for Independence is a Center for Independent Living. It is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of financial assistance awards totaling $333,113.00 with 24% percent funded by ACL/HHS and $1,026,837.00 (76%) funded by non-federal source(s) including state funds, donations, and fundraising. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS, or the U.S. Government.

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