151 Athens Way, Suite 100
Nashville, TN 37228
Phone: (615) 248-5878
Toll Free: (800) 835-7077
Fax: (615) 248-5879
 
My Personal Story
 
First Name
(of Story Teller): *
Last Name
(of Story Teller): *
Email Address: *
Street Address: *
City: *
State: *
Zip Code: *
Region: *
County: *
Day Phone: *
Evening Phone:
First Name
(of Family Member): *
Last Name
(of Family Member): *
 
Digital Photo (of Family Member):  [150x150 pixels]

Please Note: The maximum size of the digital file you can upload is 200 kilobytes. This is a standard security precaution to help us prevent denial-of-service attacks on the website, but the size should be large enough for any 150x150 photo of your family member. The digital photo is not required to successfully submit your story to us; however, if you do encounter difficulty uploading a photo, please Contact Us for help.
 
* Please provide a description of the
family member who is seeking services:
* Please describe any needs required
by the family member seeking services:
* Please describe the impact that
insufficient services has had on your family:
I give my permission to use the story as stated above in materials distributed to Tennessee Legislators for the purpose of educating them on my family member needs & services. *
I give my permission to use my family member's picture in materials distributed to Tennessee Legislators for the purpose of educating them on our needs for services. *
I give my permission to use both my story and family member's picture on The Arc of Tennessee website for educating both legislators and the general public on the needs of people with intellectual disabilities (mental retardation). *
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