My Story: I Am a Person Currently Receiving Services (Enrolled) "*" indicates required fields CompanyThis field is for validation purposes and should be left unchanged.My name is:* First Last I live at:* Street Address City State / Province / Region ZIP / Postal Code Select County*AlachuaBakerBayBradfordBrevardBrowardCalhounCharlotteCitrusClayCollierColumbiaDeSotoDixieDuvalEscambiaFlaglerFranklinGadsdenGilchristGladesGulfHamiltonHardeeHendryHernandoHighlandsHillsboroughHolmesIndian RiverJacksonJeffersonLafayetteLakeLeeLeonLevyLibertyMadisonManateeMarionMartinMiami-DadeMonroeNassauOkaloosaOkeechobeeOrangeOsceolaPalm BeachPascoPinellasPolkPutnamSanta RosaSarasotaSeminoleSt. JohnsSt. LucieSumterSuwanneeTaylorUnionVolusiaWakullaWaltonWashingtonI am a:* Person with an intellectual/developmental disability Caregiver / Family Member My state representatives are:I am currently receiving:* iBudget Waiver Consumer Directed Care (CDC+) Other I rely on these services because:Comments:*Email Address* Signature*