Financial Support Request - Recovery Resources Financial Support Fund

Financial Support Request - Recovery Resources Financial Support Fund

Please complete this Financial Support Request form if you’re in need of financial assistance to get enrolled in any of our Outpatient Recovery Programs. ***IMPORTANT Notice: Due to BHA and Court requirements, we are NOT allowed to provide scholarships for DUI, UPS or Drug Testing services***
I understand that Recovery Resources cannot provide scholarships for DUI, UPS and Drug Testing services.
Full Name

First NameMiddle NameLast Name
County of residence
In the past 6 months, have you experienced homelessness?
Mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
example@example.com
Preferred Phone Number
Format: (000) 000-0000.
Which programs will you be enrolling in? (check all that apply)
How will these programs support your recovery process?
What are your primary health, wellbeing and lifestyle concerns?
Estimated annual income (after taxes)
Please describe your financial situation and your need for financial support (250 words or less)

0/250
In a short essay, please tell us how this financial support will help you create a new story for a life of recovery and wellbeing. (500 words or less)

0/500
Anything else you’d like to share with us?
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Recovery Resources is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us.
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