Recovery House Scholarships Application

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Recovery House Scholarships Application

Recovery House Scholarships ApplicationInfoQuest Support2020-01-06T19:54:00+00:00

ATTENTION: For Scholarships be be reviewed and accepted they MUST be utilizing a pre-qualified Recovery House in our Central Pa accepted facilities. If you have NOT selected one of pre-approved partners your request will be dismissed. No further action will be taken. Calls to our hotline for Recovery applications will also not be returned unless it’s a valid request.

Scholarship Application Applicant Information

Name *

First

Middle

Last

Street Address *

City *

State *

Zip Code *

Email *

Briefly describe your reason for reaching out: *

Amount Requested *

Do you have a permanent residence? *

Which county do you reside? *

Have you previously stayed in a recovery house? *

If yes, which one? *

Owner's Name *

Owner's Phone Number *

Do you have a valid driver's license? *

Will your license be revoked in the near future? *

Do you have a car / reliable transportation to get to and from a job? *

Do you currently have a job? *

If not currently employed what is your plan to secure employment? *

Have you ever been convicted of a felony? *

If yes, please explain *

Are you required to seek treatment due to legal ramifications? *

What financial obstacles are you currently facing? If you need financial aid - please explain in further detail. *

Current / Most Recent Treatment Provider *

Providers Address *

Providers Phone Number *

Length of Treatment *

Briefly describe your short-term recovery plan *

Briefly describe your long-term recovery plan *

Meetings / Counseling *

Name

Title

Our Visitor

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