Join a Circle of Connection Thank you for your interest in joining Building Inclusive Futures. Please fill out the form below to begin the process.Participant InformationThis section should be used to provide information about the Participant of the Buidling Inclusive Futures program. The last section should be used for the Parent or Guardian of the Participant.Are you currently enrolled in or eligible for Medicaid?* Yes No You MUST be enrolled in Medicaid to be eligible for the Buidling Inclusive Futures program.We are sorry, but you are not eligible for the Building Inclusive Futures program at this time. Please contact our office for details and other resources that we have available.The Building Inclusive Futures program services ages 18 and over. Are you 18 or older?* Yes No Please answer Yes or No to allow us to confirm program eligibility.How did you hear about the BIF program?* Internet Search The Arc RI Website Newsletter Facebook Twitter Instagram LinkedIn Radio Ads BHDDH - Behavioral Healthcare, Developmental Disabilities & Hospitals Other Rules of Participation: The Building Inclusive Futures Program relies on creating partnerships. It is important to understand that your participation will contribute to your success. The program takes place over a 6 month period during which you will meet with Life Coaches and/or Mentors. If you are unable to participate in the meetings and cancel or no call/no show 3 times during the 6 months you may be removed from the program. Cancellation due to an emergency will be reviewed on a case by case basis. Please select one of the statements from the drop down. Thank You* Yes, I read and understand the rules for participation No, I need more assistance with this section If you select "No, I need more assistance with this section" you will be able to ask for further explanation. You will be asked to agree to the cancellation policy in order to participate.Participant's Name* First Last Please enter the first and last name of the individual seeking program support.Do you have an email address?* I have an email address I do not have an email address I would like help setting up an email address You MUST have to access the email address to participate in the program. Meeting links and program materials are sent via email.Email Address Phone Number*Please provide the best telephone number to reach you.Additional Phone NumberPlease provide us with a secondary contact number if available.Address* Street Address City State / Province / Region ZIP / Postal Code How do you prefer to be communicated with?* Email Phone Text Tell Us About Yourself:What activities do you like to do for fun?*Why do you want to participate in Building Inclusive Futures?*Tell us what you see for your future!Parent or Guardian InformationParent/Guardian Name - Must Be Provided for Minors.* First Last Please provide the Parent's or Guardian's name if the Participant is under the age of 18 or if the participant requires representation.Relationship To Participant* Parent Guardian Self Other Please choose one option.Phone NumberPlease provide the best telephone number to reach the Parent or Guardian.Additional Phone NumberPlease provide us with a secondary contact number if available.Email Address How do you prefer to be communicated with? Email Phone Text
