Programs

Transitional Programs and Services Application of Interest

Please Select Person Completing This Form *

Parent

Legal Guardian

Prospective TPS Student

Parent 1 /Legal Guardian Name (first and last) *

Address 1 *

Address 2 (optional)

City *

State *

Zip *

Home Phone *

Work Phone *

Cell Phone

Email *

Occupation *

Title *

Employer *

Parent 2 /Legal Guardian Name (first and last) *

Address 1 *

Address 2 (optional)

City *

State *

Zip *

Home Phone *

Work Phone *

Cell Phone *

Email *

Occupation *

Title *

Employer *

Child/Adult's Name (first, last and middle) *

Date of Birth *

Diagnosis *

Date of Diagnosis *

Diagnosis given by

Affiliated with

Town and State of Diagnostician

Other Conditions *

Current Placement *

How did you hear about the TPS Program at ELIJA School? *

Please give us a brief description of your child: *

Any additional comments:

Submit

* indicates a required field.

Upcoming

Workshops & Conferences

A Pathway To Adulthood Using Self-Direction: Transitioning For Independence 2025

May 17, 2025 - Ongoing

Pave The Way To Employment 2025

April 1, 2025 - Ongoing

Taste On The Beach 2025

May 4, 2025 - 12:00pm

ELIJA's 18th Annual Sy Schwartz Golf Outing of 2025

June 2, 2025

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