STRIDES Inquiry Form

Thank you for taking the time to complete our inquiry form and for answering the following questions. You input greatly helps us in understanding you better.

First Name *

Last Name *

Phone Number *

Email *

Birthdate (mm/dd/yyyy) *

Do you self-identify as a person with a disability or long-term health issue? *

Yes

No

I'm not sure

Type of disability *

What is your citizenship status? *

Canadian Citizen

Permanent Resident

Refugee

Other (please specify)

What city do you live in? *

What supports are you looking for from this program?  *

What is your employment goal? *

How many hours per week are you looking to work? *

Do you receive support from: (Check all that apply) *

WorkBC

Community Living BC

Mental Health Team

No

Other:

If yes, please provide a referral contact name and email address:

Contact Name

Email Address

Our team will do their best to get back to you within 2 business days. Please remember to check your junk mail or spam folder as our response may sometimes end up there. Thank you!