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Thank you for your interest in joining our program! Please complete the application below. Then we will get in touch with you about next steps.













Please select the programs you want to enroll:
HEAL
CLEAR
LIGHT

DEMOGRAPHICS INFORMATION

Birthdate 


Preferred language














Race


Country of Association


Ethnicity


Gender


Preferred Pronouns
She/Her
He/Him
They/Them
Ze/Hir

Highest level of education


Do you require any special accommodations, such as:
ASL Interpretation
Notes
Recordings
Translation

EMPLOYMENT & HOUSEHOLD INFORMATION

Employment Status


Occupation


Are you a parent or guardian of children that would be interested in the youth class (ages 4-13)?

AND / OR are you a parent or guardian of a teen (14-17) that would be interested in the adult class?

If yes, please enter here their name(s) and age(s)


Catalyst Miami's programs and services aim to prioritize those with an income that falls at or below the chart below.
Given your family size, does your income fall at or below the amount on the chart below?
Your answer to this question will not guarantee or prevent your participation in our programming.


Income Chart


REFERRAL INFORMATION

How did you hear about us?


Are you affiliated with any organizations listed below? If yes, please select them


If you marked "Other" in the previous field, please share your Organization Affiliation:



After you click Submit, you will receive an email with next steps. We will contact you as soon as possible with more details about the program!