Enrollment

We look forward to supporting you! All high school and college students are eligible to enroll in our program at any time of the year. (Please note that clients must be 15 years of age or older to obtain services. Clients under 18 require parent/guardian permission.)

Please complete each field below. Once we receive the enrollment information, we will contact you to learn more about you and how we can best support you.

If you have any questions about enrollment, please do not hesitate to Contact Us.

Student name(required)

Student DOB (must be 15 or older)(required)

Student phone number(required)

Student email address(required)

Student address(required)

High School/College/University student is currently, or will be, attending. (If not attending, leave blank)

Please choose the option the student would like to sign up for (leave blank if unsure or if your option is not listed)

Parent(s) or guardian(s) name

Parent(s) or guardian(s) phone number

Parent(s) or guardian(s) email address

Parent(s) or guardian(s) address (if different from student)

Name and contact information of person to contact regarding payment(required)

Name of person who completed this enrollment(required)

If this is your first time enrolling with us, please share any information that would be helpful, including your goals, strengths, dreams, fears, and interests

Thank you for enrolling with us!

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