ATWW Housing Assistance Application
Application For Financial Assistance into a Recovery or Care Residence Provided by the Matty Ryan Scholarship Fund
A note before you begin: This application is confidential and helps us match you with available resources. Answer each question honestly and as thoroughly as possible; it makes a difference.
Submission doesn't guarantee assistance. Accepted applicants are notified and must respond and sign an agreement to activate funding. Applicants are chosen by a committee based on first and foremost meeting the criteria, available funding, and finally the effort put forth in your About You section. Please use AI sparingly as a tool, not as the means to answer for you. We would rather have poor spelling and grammar from the heart than a thoughtless reply. If you have not received a response within 14 business days, it means you were not funded. Know that it is our desire to fund every request, but resources are limited on a monthly basis.
ELIGIBILITY
Contact Information
Applicant Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Applicant Email
*
example@example.com
Demographic Information
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Sex
*
Please Select
Male
Female
Prefer Not to Say
Race
*
American Indian or Alaskan Native
Asian/Pacific Islander
Black or African American
Hispanic
White/ Caucasian
Multiple Ethnicity
Other
What Gender do you identify as?
Preferred Language
*
English
Spanish
Other
Religion
*
Catholic/Christian
Judaism
Islam
Buddhism
Hinduism
Other
Education
What is the highest degree or level of education you have completed?
*
Some High School
High School Graduate, or equivalent (GED)
Some college credit, no degree
Associate Degree
Bachelors Degree
Masters Degree
Professional Degree
Doctorate Degree
Location
Country of origin? (If United States, which state?)
*
What zip code was your last know address in?
*
Living Status
*
Homeless
Living with Family
Renting
Treatment Center
Other
Family
Marital Status?
*
Single
Married
Separated
Divorced
How many children do you have?
*
None
1
2-4
More than 4
Do you have custody of your children?
Yes
No
Employment
What is your current employment status?
*
Employed Full-Time
Employed Part-Time
Unemployed
Who is your current or last employer?
*
How long have you been apart of this company? (If Previous employer, how long were you with the company?)
*
What is your total annual income?
*
$0-30,000
$31,000-$60,000
$61,000-$90,000
$91,000-$120,000
$120,000+
Military
Have you ever served on active duty in the U.S. Armed Forces, Military Reserves, or National Guard?
*
Yes
No
Medical
Are you receiving MAT services? (Medication Assisted Treatment)
*
Yes
No
Do you have any disabilities that would affect being housed in a Recovery Residence?
*
Yes
No
Do you have any medical conditions?
*
Yes
No
If yes, please explain briefly so we know how best to serve you. (To your comfort level, this is not a required question.)
Legal
Do you have any current legal involvement?
*
Yes
No
Do you have any past criminal convictions
*
Yes
No
Recovery
What is your Sobriety date? (If Applicable)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What was your primary substance of choice?
*
What is your longest period of sobriety?
*
How many times have you been to treatment?
*
0
1
2
3
4
>4
Have you ever lived in a recovery residence before?
*
Yes
No
Who referred you to this Housing Assistance Program?
Referral Name
*
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Referral Email
*
example@example.com
Company
Upload Reference Letter here:
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Must be from a Recovery Professional involved in your current treatment program.
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About You
In your own words describe your journey with addiction that has brought you to this point.
*
How would receiving this assistance impact your life?
*
What motivates you in your Recovery?
*
We review awarded funding every 30 days to determine continued support. Funds are limited. What is your financial plan to supplement or take over your own housing costs when the time comes?
*
What recovery residence are you looking at moving to?
*
What is your estimated move-in date? (This can be your best guess if you're timing is uncertain)
*
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Submit
Today's Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Should be Empty: