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Sober Living Scholarship Application

  1. Gender*

  2. Are you or could you be pregnant?*

    This will not affect your application it will only help with placement. Please check the appropriate response below

  3. Have you previously applied for our Scholarship within the past three months?*

  4. Are you willing to discuss any medical conditions you may have that we or the sober house should be aware of?*

  5. Are you willing to discuss any medications you are currently taking?*

  6. Are you willing to relocate for a minimum of 30 days?*

  7. Do you understand this application is not for a specific rehab or program? We will review your application and if eligible will place you in a facility of our choice. If you understand and still want to apply select YES below:*

  8. If you are eligible for a scholarship it will take a minimum of 48 hours for us to review your application and respond. Please confirm you understand this and select YES below:*

  9. Are you willing to meet with a Recovery Coach to discuss how your recovery is progressing and establish your continued need for a scholarship?*

  10. Are you willing to go to detox and 30 days of treatment before entering a recovery house?*

  11. Are you willing to provide your health insurance information during a potential follow up interview? If you do not have any coverage select N/A below*

  12. Are you open to being required to go to meetings?*

  13. Leave This Blank:

  14. This field is not part of the form submission.