To participate in Express Yourself programs, a completed intake application is required.
Please note before you begin:
- You will need Emergency Contact and Health Insurance information for the applicant.
- At any time, you may click “Save and Continue Later” at the bottom of the form and complete the form at another time.
- If you prefer, you may download a PDF of this form to complete manually and mail to:
- Express Yourself, 100 Cummings Center, Suite 165-E, Beverly, MA 01915.
Our programming is supported by private grants and government contracts that require particular information to continue funding. All data collected is kept confidential.
Parents, click below to begin the application process. This information is required for youth who are not affiliated with an agency.
Agencies, click below to begin the application process.
Questions about the application process?
Please contact Kristi Jeffers at (978) 927-8600 or via email: