Scholarship Application Applicant Information

Please answer the questions below to the best of your ability as we use this information to decide financial assistance. Note – the information you supply to The Natalie Cribari Drug Awareness Fund is confidential and will not be shared with any other party or person(s).

HOUSING

TRANSPORTATION/EMPLOYMENT

LEGAL

FINANCIAL

THIS PORTION TO BE COMPLETED BY THE INDIVIDUAL REQUESTING FINANCIAL ASSISTANCE FOR RECOVERY HOUSING. SHOULD SPECIAL CONDITIONS NEED TO BE CONSIDERED REGARDING THIS MATTER PRIOR APPROVAL MUST BE RECEIVED IN WRITING FROM NCDAF.

CURRENT TREATMENT INFORMATION/ONGOING RECOVERY PLAN

Disclaimer: I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information in my application may disqualify me from being eligible for financial assistance.
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