Intake Form

Exit Survey

Hello: In order to receive services, we need you to complete this intake form for our records. It may take 30 minutes to complete.

Please make sure to read each question carefully.

Your responses will be strictly confidential and this website is highly secure. If you have questions at any time about the form or the process, contact your local office/organization.

NCIDC, SCAIR, and Walking Shield Office Numbers
Northern California Indian Development Council's (NCIDC) Eureka office number is (707) 445-8451 or you can call us toll free at (800) 566-2381. NCIDC serves all counties in California that are not listed below, as well as 22 counties in Oregon.

SCAIR's San Diego office number is (619) 328-0676. This office serves San Diego County and Imperial County.

SCAIR's Ventura office number is (805) 765-6243. This office serves Monterey County, San Benito County, Santa Barbara County, Santa Cruz County, San Luis Obispo County, Sonoma County, and Ventura County.

Walking Shield's Costa Mesa office number is (657) 900-2197. This office serves Orange County, Riverside County, and San Bernardino County.

Please start the survey now by clicking on the Next button below.