Express Yourself Application
Thank you for applying to Express Yourself! Membership will be limited to 20 individuals. Please contact me at with any questions. Both boys and girls welcome. The program is completely free. No prior experience with the skills included in the workshops necessary. You do not need to make all the dates to participate! You can apply still once the program has begun, there is no application deadline.

Eligibility Requirements are as follows:
- Must be age 12-19
- Have a disability
- Fully complete application

Email address *
Last, First Name *
Your answer
Age: *
Your answer
Cellphone: *
Your answer
Parent/Guardian Cellphone *
Your answer
Disability (so accommodations can be made if need be): *
Your answer
What workshop dates work with your schedule? *
Do you require any accommodations?
Your answer
Any allergies or food restrictions?
Your answer
How did you hear about the program?
Your answer
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