Scholarship Fund
Application For Financial Assistance into a Recovery Residence Provided by the Matty Ryan and/or The Parker Johnson Funds
Thank you for your desire to continue your recovery journey! In order to complete this application process, you will need these things ready to upload:
Do you have ready for submission:
DISCLAIMER: This confidential application is solely for the purpose of connecting the applicant with available resources. Please be as thorough as possible and take the necessary time to answer all the questions thoroughly and honestly. This application has no guarantees or implications that resources will be provided. If your application is accepted, then you will enter the interview stage. This is a multi-step process, so please apply in a timely matter. If awarded a scholarship, all assessment and intake procedures will be coordinated and completed before your admission to a recovery residence.
ELIGIBILITY
Contact Information
Applicant Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Applicant Email
*
example@example.com
Demographic Information
Date of Birth
*
-
Day
-
Month
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
Portuguese
French
Mandarin
Arabic
Other
Religion
*
Catholic/Christian
Judaism
Islam
Buddhism
Hinduism
Other
Not Applicable
Prefer not to say
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
Homeowner
Family
Marital Status?
*
Single
Married
Separated
Divorced
How many children do you have?
*
None
1
2-4
More than 4
Do you have custody
Yes
No
Employment
What is your current employment status?
*
Employed Full-Time
Employed Part-Time
Seeking Employment
Not Employed
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
Which branch did you serve in?
*
Medical
Are you receiving MAT services? (Medication Assisted Treatment)
*
Yes
No
List all medications you are currently prescribed
*
Do you have any disabilities that would affect being housed in a Recovery Residence?
*
Yes
No
Do you have any medical conditions?
*
Yes
No
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?
*
-
Month
-
Day
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
What organization are you currently receiving your substance abuse treatment through?
*
Who is the recovery professional referring you for the ATWW Scholarship?
Referral Name
*
First Name
Last Name
Phone Number
*
Please enter a valid 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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of
About You
In your own words describe your journey with addiction that has brought you to this point.
*
How would receiving this scholarship affect your life?
*
What are your greatest strengths?
*
What areas have you determined to be areas of weakness?
*
What motivates you in your Recovery?
*
If you received a hand-up in the form of a scholarship, how would you pay it forward in the future?
*
Upload your 500-word essay here
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Who is your preferred service provider or sober living community?
*
How did you hear about the All the Way Well Scholarship Funds?
*
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Submit
Today's Date
-
Day
-
Month
Year
Date
Amount Awarded
Award / placement conditions
Is peer support required
Yes
No
Group sessions
1:1 sessions
Total weekly peer support hours
Funding source
Please Select
PRS Services
Signal
ATWW Fund
Discount
Other
Program applicate is approved for
Please Select
Trailhead Program
Bryant Gardens Program
Standard 1 Month SLO Scholarship
Awarded SLO
Please Select
Elevate
Sophrosyne
I Am
Threshold
Invent
Thrive
Should be Empty: