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Beacons - General Interest Form

Thank you for your interest in Beacons Inc.! We’re so excited you’re here and are grateful for the opportunity to connect with you. This is the first step toward joining one of the amazing programs we offer at Beacons.

Once you complete this form, a member of our team will reach out by email or phone to learn more about your interests and help determine which Beacons program may be the best fit for you.

Thank you again for your interest! We look forward to connecting with you and supporting you on your journey! 

Bethany Britt, MA 

Director of Partnerships and Outreach

bbritt@beaconsnorthcounty.com

Office: 760-448-6230
Cell: 442-404-2336
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Email *
Participants Name *
Person's name who is completing this form *
Best phone number to reach you *
Parent/conservator name *
Which program are you interested in (Check all that apply) *
Required
Please choose the answer/s below that best match the perspective participants situation.  (Check all that apply) *
Required
Age of perspective participant *
Please read Beacons' entrance criteria, before answering the following questions.  *
Is the applicant independent in their self-care?  *
Is the applicant capable of communicating their basic needs? *
Is the applicant capable of functional communication with peers and instructors? *
Does the applicant require the support of a personal care attendant or 1:1 support due to medical or other issues? *
Does the applicant display any disruptive or maladaptive behaviors? *
Does the applicant have access to transportation to and from the program? *
Thank you for completing Beacons General Interest Form! We will be in contact soon! 
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