Site Map

About Roger

Presentations (New!)

Curriculum Vita

Contact Me

Description of Business

Copy Right Issues

Articles and Writings

Bea Baxter Meyer


Portland Oregon Adult Resources

Current Research Projects

Hubert Cross Website


"…of a different mind"

Email rogernmeyer@earthlink.net

Phone/FAX 503-666-2776

Cell:  503-358-6463

18162 E Burnside

Portland, OR  97233







I, __________________________________________________, hereby authorize Roger N. Meyer, DBA "…of a different mind" to be my disability advocate with the agency or the professional listed below.


     Mr. Meyer is authorized to conduct conversations and official business relating to my disability with the person(s) and agency listed below.


     This authorization is effective as of the date of my signature, and can be revoked by me at any time.  If my case is transferred to another agent or professional within the agency, this agreement shall remain in force.  Absent my revocation, this authorization and release will remain in effect for ninety days following the closing of my case and/or file with the agency.




PERSON OR AGENCY___________________________________________________


Professional or agency address_____________________________________________


Purpose of consultation/contact_____________________________________________






X________________________________________       Date_______________________








Student and Adult Disability Advocacy               Professional In-Service Education                 Case Management

    Consultant on Non-Verbal Learning Disabilities, Asperger Syndrome and  High Functioning Autism


Go to the Top