ADMISSION FORM

Please fill out completely and clearly and submit with application and supporting documentations. Please note failure to return in a timely manner may delay enrollment.

Steps of enrollment:

  1. Complete an application form and an intake form to determine qualification for the prospective trainee.
  2. Program Manager to notify whether the prospective trainee is qualified for the program or not.
  3. If qualified, parents/guardians and the prospective trainee come in for a tour; and then complete an enrollment packet.
  4. A start date will be set for the prospective trainee after the enrollment is finalized.

Note: both the application and in-take form must be submitted for consideration.

**Please provide proof of guardianship, such as a guardianship letter.
Does applicant receive the following?
**Please provide proof of benefits, such as award letter or copy of card.
Agency Provider (If Applicable)
**Please provide a copy of applicant’s diagnosis.
I attest that all information provided is true to the best of my knowledge. I understand that intentionally omitting or falsifying information can lead to immediate termination from the HEART Program.
Form issues: Sbaron@heartprogram.org and Ssimmonsgould@heartprogram.org Shyra Baron (713) 263-3795 Sheree Simmons- Gould (713) 893-8857
Submitting Application Does Not Guarantee Acceptance Into The HEART Program

Note: both the application and in-take form must be submitted for consideration. please go back to menu and click apply / intake form after submitting this form.