Request a Tour | Everstand

Name*

Prefix First Last

E-mail Address*

Phone Number

(Cell Preferred)

Where are you from?*

City State

Which program or campus would you like to tour?*

Please note tours are not available for all programs.

Which of the following best describes your request?*

General interest / requesting a tour
Considering Admission / Referral to program

Approximately how many people, including yourself, would like to tour?*

We ask that tour groups have a minimum of five members.

Please enter a number from 1 to 100.

Tell us a little bit about your group*

It is helpful for us to know the approximate age range of the group. Would any members of your group have difficulty walking and standing for about 30 minutes?

Do you have some dates and times in mind?*

Tours are available during typical business hours (Monday-Friday from 9AM-5PM). Requests for after-hours and weekend tours are handled on a case-by-case basis and reserved for larger groups of ten or more (10+) people.

Due to the volume of requests, tours are typically offered to prospective families only. If this describes your intention, please change your selection above to "considering admission." If you wish to tour the DC program for a reason other than admission, let us know in the comment box below.

DC ELP - Tour Request Information

DC - How many children are you looking to enroll?*

One (1)
Two (2)
Three or More (3+)

DC - Requested Enrollment Date:*

Please enter your anticipated or needed enrollment date. If you are expecting (congratulations!) please estimate your desired enrollment date.

DC - Tell us a little more about who you are interested in enrolling:*

For example, ages of children you wish to enroll.

DC - Requested Tour Date*

Tours are offered every Wednesday at 10:00 a.m.

Confidentiality Note

Please do not enter confidential information into this form. Everstand's staff will call you to discuss your specific admission or referral case.

Strawbridge - What is your relationship to the student?*

e.g., social worker, parent, guardian, etc.

Strawbridge - What grade is the student currently in?*

Strawbridge - What school is the student currently attending?*

Strawbridge - Does the student have an Individualized Education Plan (IEP)?*

An IEP is typically required in MOST cases for admission to Strawbridge. Our staff can help during the introduction phone call.

Yes, they have an IEP.
No, the do not have an IEP.
I'm not sure.

Strawbridge - Anything else you'd like to tell us about who you are interested in enrolling:*

Please do not enter student names or other confidential information via this form. A member of our staff will contact you directly to learn more.

Is this request affiliated with a group or company?*

e.g., church, synagogue, company, community group, scouting organization, youth group, etc.

Yes
No

Group Name*

Please enter the name of your group.

What is the city and state where your group is located?*

City State

What COUNTY is the admit or student from?*

What best describes YOU as the person filling out this form?*

State Employee (e.g. DJS, DSS, DHR, DHHR, Court)
Youth who would be admitted
Family or friend of potential admit

Which state agency or office are you from?*

Would you like to tour just to learn more about Everstand or tour with a prospective client?*

Either answer is great!

For my own education / no client.
With a client / prospective admission.

Are you currently working with a state agency?*

Yes
No

Which state agency or office are you working with?*

How old are you?*

20 or Under
21 or Over

Do you know the contact information for your state-assigned social worker?*

Everstand will contact YOU first, but eventually we will need to work with your state-assigned social worker to process any admission request.

Yes
No

Unfortunately, Everstand does not accept private pay clients for the program you've selected above. A referral is required from a state agency for admission. Youth must be under the age of 21 for placement in Everstand's residential program. You are still welcome to submit this form and a member of our admissions team can point you in the right direction on how to contact your local state agency's office (e.g. DSS, DJS, DHR, DHHR).

Unfortunately, Everstand does not accept referrals for children over the age of 21 at the program you've selected. Please adjust your program location and/or interest focus to continue.

What is your relationship to the prospective admit?*

Is the prospective admit currently working with a state agency?*

Yes
No

Which state agency or office is the prospective admit working with?*

Unfortunately, Everstand does not accept private pay clients for the program you've selected above. A referral is required from a state agency for admission. Youth must be under the age of 21 for placement in Everstand's residential program. You are still welcome to submit this form and a member of our admissions team can point you in the right direction on how to contact your county's local office (e.g. DJS, DSS, DHR, DHHR).

How old is the prospective admit?*

20 or Under
21 or Over

Unfortunately, Everstand does not accept referrals for children over the age of 21 at the program you've selected. Please adjust your program location and/or interest focus to continue.

Do you know the contact information for the state-assigned social worker?*

Everstand will contact you first, but eventually we will need to work with the potential admits' state-assigned social worker to process any admission request.

Yes
No

State Social Worker's Name*

State Social Worker's Phone

Office or Cell

State Social Worker's Email

Comments

This field is for validation purposes and should be left unchanged.

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Confidentiality Note