Sober Living Scholarship Application

Please complete this form to apply for our sober living scholarship program. Our team will review your application and reach out to you within 48 hours.

*Note: Scholarships are based on available funds and donations and are not guaranteed for every applicant.

Scholarship Application

Please fill out the form below to apply for the sober living scholarship.

Applicant Info

First Name

Last Name

Date of Birth

Month

Day

Year

Phone Number

Email Address

Current Address

Emergency Contact Name

Emergency Contact Phone

Recovery & Background

Are you currently in recovery?

Yes

Sobriety Date

Current Treatment Involvement

Previous Sober Living or Treatment Programs

Legal Obligations

Employment Status

Employed

Not Employed

Financial Need

Monthly Income

Financial Assistance Received

Amount You Can Contribute Toward Monthly Rent

Reason for Requesting Scholarship Assistance

Participation Commitment

How do you plan to stay accountable and engaged?

Personal Statement

Agreement & Signature

I agree that the information provided is accurate to the best of my knowledge.

Signature

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Date

Month

Day

Year