Adult Education

Horticultural Therapy Services

Application for Services

Any misrepresentation of the facts in this application will result in the agency being withdrawn from consideration for a horticultural therapy program with the Chicago Botanic Garden.

Acceptance of your application will be subject to availability of schedule openings and an orientation meeting. You will be notified upon receipt of your application. If accepted, your agency will be scheduled for an orientation interview. Information exchanged at the orientation meeting will support final acceptance of the contract.

If available, please also submit a copy of your annual report to:

Chicago Botanic Garden
Horticultural Therapy Services
1000 Lake Cook Road
Glencoe, IL 60022

Please call (847) 835-8247 or visit horttherapy@chicagobotanic.org if you have questions.

Items market with a * are required. Form will not send unless these fields are filled in.

*Name of Agency:    
*Applicant name: Administrator name:
*Applicant email: Administrator
phone:
Street address: Fax:
City:  
State/Province:
Zip/Postal code:

If in Chicago, please indicate
neighborhood name:

Ward number:

Ward alderman:

For Cook County agencies, please provide Forest Preserve District of Cook County District number:

County commissioner name:

This application is for:

Six-Month Outdoor Gardening Program
Six-Month Indoor Gardening Program
Year-Round Gardening Program

What audience does your agency predominantly serve?

(Please describe your audience, including current functional abilities, to help us better tailor your program.)

Number of beds:

Number of clients served
(day treatment):

Is your agency not-for-profit:

Yes No

Is your facility part of a chain of agencies?

Yes No

If yes, what is the name of your "umbrella" organization:

Is the agency currently accredited?

Yes No

Accrediting agency:

Staff working with the horticulture program:

Name:  

Title:    

Phone: 

Name:  

Title:    

Phone: 

Name:  

Title:    

Phone: 

List any sponsoring agencies connected with this project, such as Mental Health Association, Council for Aging, etc.:

Organization:

Contact:

Phone: 

Organization:

Contact:

Phone: 

Organization:

Contact:

Phone: 

In what department would the horticultural therapy program take place?

Describe current program content of that department:

What are your goals for the program?

What are your goals for the individuals you serve?

Do you have an existing garden area? If yes, please describe.

How did you learn about our horticultural therapy program?

  

Our goal in offering these 6- and 12-month programs is to create and deliver a program which your institution's staff will be able to sustain on a long-term basis, for the benefit of your constituents. If you are not in need of a comprehensive solution, you may wish to take advantage of our Gardening for Life Enrichment day programs.


Private Krankenversicherung