Beat The Street Application

Elementary Grades K-5th | Middle School Grades 6th-8th | High School Grades 9th – 12th

Our Mission is to: Empower youth and children by building a foundation for them to live responsibly and successfully.

Our Motto: More, Better, Before it is expected of us. We want to do MORE, we want to do BETTER, and want to do BEFORE IT IS EXPECTED OF US.

Overview: The goals of the Beat The Street program is to help clients develop skills that will do the following:
• Enhance our client’s ability to reach independence
• Enhance our client’s understanding of self-sufficiency and financial independence
• Help clients master additional tools needed to reach greater potential
• Enhance social skills, self-esteem and life skills 

Program Goals
• Increase Academic Ability
• Develop Positive Socialization Skills
• Develop Self Esteem & Give Empowerment
• Provide Family Dynamic Skills to Enhance Mutual 
• Family Attachment & Warmth

Program Consent – Please read ALL the terms of participation in Beat The Street below:

• Virtual 7pm (Monday – Elementary, Tuesday – Middle School, Thursday – High School)

Participant Expectations
• Turn in weekly school progress reports
• Turn in weekly home behavior goal sheets
• Set weekly development goals
• Maintain a C average in school
• Demonstrate positive behavior while participating in 

BTS Program Staff Expectations
• Provide participant with tutoring & mentoring services
• Help participant set weekly goals
• Case Management Rewards

Participants will earn rewards during the program.

Monthly/Quarterly Family Nights
We will get together with participants and family to provide opportunities for additional education and activities to enhance family bonding and socialization skills.

*If you would like to print this app, instead of filling it out online, click here

Participant Information:

Name * Phone Select FemaleMale Date of Birth * Social Security Number Insured Member Insurance Provider Insurance Provider Phone Insurance Group Number Member ID #: Home Address: City, State, Zip code: Home Phone: Mobile Phone: Work Phone: Email * Date of Birth * Name of School: Grade: Last Grade or Degree Earned:

Parent Information:

Name Social Security Number: Home Address: City, State, Zip code Home Phone: Mobile Phone: Email: Employer: Work Phone: Family Physician: Physician Office location: City, State, Zip code Referred By: Emergency Contact: Emergency Contact Phone Number: