Contact UsFind UsBusiness Office 225 Roswell Street, Alpharetta, GA 30009 Get DirectionsVocational Training Center 12624 Broadwell Road, Alpharetta, GA 30004 Get DirectionsContact Us678.691.4644 lionheartworks@lionheartlifecenter.com Fax 770.772.1871Lionheart Tech Site 12624 Broadwell Road, Alpharetta, GA 30004 Get DirectionsLionheart Radio USA 12624 Broadwell Road, Alpharetta, GA 30004 Get DirectionsLionheart Gardens 1931 Gaddis Road, Canton, GA 30115 Get DirectionsThe Cottage 160 Academy Street, Alpharetta, GA 30009 Get Directions Order Number Parent/Person Inquiring Section Please complete the form below so that we may be able to contact you and provide you with additional information. Last Name First Name Email Phone I am interested in... * – Please choose – Applying for Lionheart WORKS Applying for WORKS Summer 2021 Becoming a community partner/worksite Becoming a Job Coach Becoming a supporter of our non-profit Other If you are interested in joining The Lionheart WORKS Program, please fill out the Participant Information Section below. Participant Information Please complete the form below so that we may be able to contact you and provide you with additional information. Last Name First Name Age Birthday Diagnosis COVID Vaccination Status Vaccinated Not Vaccinated COVID Vaccination Status IEP/CBI County Past School/Program History Present School/Program Academic Grade/Level Communication Skills Accommodations Needed Work interests and any work experience GVRA Yes No Counselor NOW/COMP Yes No Support Coordinator
