Sober Living Scholarship

Date of Application:

Applicant's Name:

Your email

Applicant's Current Place of Residence:

Address of Current Place of Residence:

Amount of Scholarship/ Funding Requested:

House Manager Name (If Applicable):

House Manager Contact Information (If Applicable):

How did you hear about us?

Please share your personal history of addiction:

Please explain how receiving financial assistance from this foundation will assist you:

What is your inspiration to maintain long-term recovery?

What habits do you wish to develop that will assist your long-term recovery?

What are your long-term personal goals?

I understand that funding is to help offset costs associated with my rent and are paid directly to the facility.

Signature of Applicant:

Signature of House Manager:

Date:

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