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Participant Intake & Agreement

Participants can begin online by completing this intake and agreement form. A printable PDF option is also available for people who prefer paper records or need to submit documents in person.

Complete Online Download Intake PDF Download Agreement PDF

01 Complete intake

Share contact, referral, emergency contact, and program track information.

02 Accept agreement

Confirm attendance, respect, stewardship, payment, and program expectations.

03 BUSI review

BUSI reviews the record and provides case access when participation is approved.

Online submission

Submit participant intake to BUSI

Do not enter Social Security numbers or banking information in this form. Court or agency documents can be delivered directly to BUSI when requested.

Participant Information

Automatic BUSI reference Full legal name Email Phone City Date of birth Preferred contact method

Use this automatic BUSI-001 style reference for follow-up. For new participants, this is the only number needed at intake, review, and curriculum access.

Program and Referral

Program track Referral source Court, agency, or referring person

Reason for participation or support request

Emergency Contact

Emergency contact name Emergency contact phone Relationship

Agreement Acknowledgment

I understand attendance, participation, and respectful communication are required. I understand BUSI curriculum and support are educational/community services and not therapy or legal representation. I understand payment, sponsorship, or sliding-scale arrangements must be documented when applicable. I understand certificates are issued only after BUSI verifies completion requirements.

Typed participant signature Date signed