Are you ready to make a big change in your life? We can’t wait to help you.

If you have spoken with an Eben staff member, complete this form to apply for our program.

Please note: This is a long form, so it is recommended to speak with an Eben staff member before applying to ensure that Eben’s program is a good fit for you. Please reach out to us at (816) 388-0405 to inquire about our program.