Expression of Interest for Prospective Guests

Eli's Place is a voluntary residential mental health program for young adults aged 18 to 35. This form helps us understand whether our program may be a good fit. It takes a few minutes to complete.

Any information collected in this form will only be viewed by Eli’s Place Admission Staff for the purpose of determining eligibility. 

Please Note: you must click "submit" at the end of the form to complete the Expression of Interest.

We encourage you to review the Eli's Place Program Overview if you have not done so already: https://elisplace.org/program/

Please know:

• This is not a clinical assessment. 
• Completing it does not guarantee admission.
• Answer as openly as you can. Your answers are kept confidential and are used only to plan next steps with you.
• You can stop at any time.
• If you are completing this for someone else, answer each question about them.

If you or someone you know is in crisis right now, do not wait for this form. Call or text 9-8-8 (Suicide Crisis Helpline) or call 911.