waitList

Individual's full name *

First

Last

Individual's home address line 1 *

Individual's home address line 2

Individual's city *

Individual's zip *

Is individual seeking a full time (M-F) or part time position? *

Full time
Part time

Guardian *

Guardian's name *

Guardian's email *

Email

Confirm Email

Guardian's phone number *

Service Coordinator's name *

First

Last

Service Coordinator Phone Number *

Service Coordinator Email *

Behavioral Needs *

Please select any needs that may apply

If "Other", please explain *

Medical Needs *

Please select any needs that apply

If "Other", please explain *

Does Individual require use of a wheelchair? *

Yes
No

Preferred Location *

Which team would be a more appropriate fit for this Individual? *

Blue
Green

We have two teams at all R friends. A green team and a blue team. Both groups work on continuing education and skills to help our individuals become more independent, however our green team is focused more on life skills and the educational activities and skills are at a pre-school / elementary level and has a 1 to 3 staffing ratio. Whereas our blue team group is focused more on job skills and the educational activities and skills are more in line with middle school/ high school levels and has a 1 to 6 staffing ratio. Each team currently has a wait list.