Your next chapter can begin with one conversation.

Tell us which SCRIP program interests you. A member of the SCRIP team will review your information and contact you about eligibility, availability, and next steps.

People firstA short interest form—not a full intake.Privacy mattersDo not submit confidential records here.

Apply for a program

Help us connect you to the right pathway.

This form may be completed by an interested participant, family member, referring professional, or community partner.

Important: Please do not include Social Security numbers, medical or clinical information, legal documents, correctional records, or other confidential information. SCRIP will request appropriate documents securely if needed.

Prefer email?ed@scripconnect.orgPrefer to call?860.400.2488

Your name *I am completing this form as *Email address *Phone number *Age range *Preferred contact *

SCRIP programs — select one *

Choose the program name that best matches the support you are seeking.

Program 01

ASCEND (Adults 26+)

Structured behavioral change and professional development support for adults age 26 and older.

Program 02

Youth RISE / Urban Echoes (Ages 14–25)

Trauma-informed personal development, creative expression, and digital storytelling for young people ages 14 through 25.

Program 03

COPE — Career Opportunity Pathway to Employment

Direct employment preparation and job connection support for people ready to enter the workforce.

Program 04

Stick to the SCRIP

Reentry guidance, stabilization, referrals, and ongoing community support.

Program 05

Urban Male Initiative

Mentoring, personal development, accountability, and positive community engagement for men and boys.

Program 06

Not sure — please help me choose

Select this option and a SCRIP team member will help identify the most appropriate program.

How did you hear about SCRIP?City or townWhat support are you seeking? *

What happens next

Interest today. A guided next step tomorrow.

Review

SCRIP reviews your basic information and program interest.

Connect

A team member contacts you to discuss eligibility and current availability.

Complete intake

If the program is a fit, SCRIP schedules the appropriate secure intake process.