Apply to PEI REACH Foundation - Application

If you would like to send an application for a REACH Foundation program or service, fill out the form below.
If applying for a program, we will contact you during our next program intake.
If applying for a service, we will contact you as soon as possible.

FINDING YOUR PATH; 3 hours a day Monday - Friday; 3 weeksEXPANDING YOUR REACH; 7 hours a day Monday - Friday; 12 weeks

WHO IS COMPLETING THIS APPLICATION? * Self ReferralFamily/Friend ReferralReferral by Supporting Agency

FIRST NAME *

LAST NAME *

EMAIL ADDRESS *

PHONE NUMBER *

PROVINCE OF RESIDENCE *

Program clients must be 30 years or younger to be eligible for REACH programs. Please confirm that you are 30 years of age or younger. *

Confirm

PREFERRED PRONOUNS

REASON FOR THE APPLICATION TO THE PROGRAM *

ANY OTHER INFORMATION YOU WOULD LIKE TO PROVIDE?

ALTERNATE CONTACT NUMBER

RELATIONSHIP

Please prove you are human by selecting the car.

Apply To Be A Part Of The Next Set Of Reach Programs.