Navigation Support Intake Form

ICS Foundation provides non-clinical navigation support to help individuals, families, and organizations understand and access public benefits and community resources.
This intake helps us understand your situation and determine whether we can offer next steps. Submission does not guarantee services.

Who is this request for? *

An individual or family

An organization seeking help for one or more people

Option An organization seeking help understanding or setting up navigation3

Not sure

Do you currently receive SSI or SSDI benefits?

Do you currently have Medicaid coverage?

Where is support needed?

Washington, DC

Maryland

Other / Not sure

In your own words, briefly describe what’s going on (What’s making this hard to navigate right now?)

What are you trying to navigate right now?

Health coverage or Medicaid

Long-term services or disability supports

Housing or housing-related services

Reentry or returning citizen supports

School, youth, or family-related services

Multiple systems at once

Not sure / need help figuring it out

If this is for an organization, name the organization!

Is there a time concern we should be aware of?

Yes — something is urgent

There is a deadline, but it’s not urgent

No immediate timeline

Not sure

If there is a deadline or urgent issue, briefly note it here (optional)

First Name

Last Name

Phone *

Email *

I understand this is non-clinical navigation support and that submitting this form does not guarantee services. *

Yes

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.