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The Wallet Card Application
This is the application to get a wallet card for yourself as a person with a disability. Your application should take 2 weeks to process.



You will be asked several questions to make sure that we have the correct information to make your custom wallet card.


Write your FIRST name the way you want it on the card.
 *




Write your LAST name the way you want it on the card.
 *




Email Address - we need this in case we have questions about your application.
 *




Mailing Address – this is the address we will use to mail the wallet card to you.
 *




Disability – pick your main disability either Autism Spectrum Disorder (ASD) or Intellectual Disability.
 *




Second Disability – you can add a second disability if you think it is important for the police to know. You must limit this to 20 characters including spaces.




Custom Statements – If you want to customize your card you can pick from one of the choices in the dropdown menu or you can write a custom statement. You must limit the custom statement to 50 characters including spaces.




Emergency Contact Information – you must have at least one emergency contact. You may NOT put yourself as the emergency contact. Write the name and phone number of your emergency contact.

 *
 *
 *
ext.




You can add a second emergency contact if you want. You may NOT put yourself as the emergency contact.

ext.
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