Carson’s Wings of Hope Financial Aid Application

Financial Aid Application Form

Carson's Wings of Hope
Does the cost of treatment for substance abuse, treatment and/or mental health concerns discourage you or a loved one from seeking help? To make treatment attainable, we offer financial assistance to support the recovery process.

We suggest that you first check with your medical insurance provider to understand what coverage you have for treatment. The passage of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act both have drastically changed how addiction recovery is viewed under many health insurance plans. Treatment for addiction is generally considered a covered medical condition. These federal laws also include individual health insurance coverage, not just large group plans.

Here is a list of additional resources for you to consider helping offset the cost of treatment:

·         State-funded substance abuse programs & detox addiction treatment Programs

·         Substance Abuse & Mental Health Services Administration (SAMHSA) grants

·         Medicare & Medicaid

·         US Department of Veterans Affairs
Personal Data:

Tell us about yourself
Full Name:*

First NameLast Name
E-mail :*
Where the confirmation will be send to
Home Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile No.:*

Area CodePhone Number
Birth date:*

MonthDayYear
Reason for applying:

0/300
Name and address of detox, rehabilitation, or other mental health related facility you would like to attend
What treatment programs have you tried in the past? Please include names, addresses and dates:

0/300
How much money are you requesting ?
Are you currently in danger of hurting yourself or others?
Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
All applications will be reviewed by our executive team and you will be notified within 14 business days. (There is no guarantee that all requests will be granted.)

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Should be Empty:

Financial Aid Application Form

Personal Data:

Applicant's E-Signature