All For Recovery Application & Waiver

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    All For Recovery Application & Waiver

    All For Recovery uses a detailed online application system. Fill out the application in its entirety for grant consideration. Please contact us if you have any questions.  

     

    APPLICANT INSTRUCTIONS:

    1. Fill out the ENTIRE application. An incomplete application will not be granted approval. You MUST submit the first invoice from the facility which you are applying for funding after your application has been approved.
    2. Please go into as much detail as possible for all sections of your application. This allows us to see the whole picture of how we may best be able to assist you in your own words. 
    3. Once your application has been submitted, it will go before the AFR Board for initial approval. 
    4. If approved, you will receive an email with an assigned time to speak with a member from our All For Recovery team. This is a call between just the two of you, so please allow at least 10 minutes. If your scheduled call with AFR is missed without prior notice to reschedule, this will forfeit your grant opportunity. NO EXCEPTIONS!
    5. After your call, final approval goes back in front of the AFR Board. Within this period, you will have expectations and tasks to help assist you through your recovery process. You will find more information on these on the Expectations page of this application package.
    6. If all expectations are met within the first 2-weeks, funding for 2-weeks of rent will be sent directly to the housing facility. Within the following 2-weeks, the same process will repeat. A total of 4-weeks of funding will be provided.

    TREATMENT MANAGER OR RECOVERY HOUSING MANAGER:

    • Treatment Application approvals take place within 24 business hours of receipt confirmation.

    • Recovery Housing Application approvals take place within 7 business days of receipt of confirmation. Application reviewals take place on Monday and Thursday evenings.

    • Payments are processed & delivered at the end of each two-week period & will be made by credit card/check.

    • We offer grants for a two week period, with the opportunity for another two weeks based upon progress.

    • The 4-week invoice is required to be submitted by the facility upon final approval.


    The Facility Manager MUST check-in with AFR before the 2nd payment becomes due and let us know how the applicant is doing & discuss how progress is going. At that point, we will process the payment for an additional 2-weeks of grant money if the applicant has completed all AFR required tasks to aid in their recovery.

    If you are interested in obtaining treatment or recovery housing for a loved one or friend – please complete the application in detail and submit for board approval.

  • GRANT APPLICATION

  • Today's Date*
     - -
  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Have you previously applied to AFR?*
  • Did you receive funding?

  • Health Insurance

  • Do you have health insurance? (If Yes, please fill in the information below)*
  • Relationship to Applicant
  • If you do not have insurance, is self-pay an option to cover the premium?
  • Format: (000) 000-0000.
  • Do you currently receive any other funding?*

  • Employment

  • Are you currently employed?*
  • If No, are you willing to complete job applications?*
  • Do you receive any other type of income? (check all that apply)*

  • Medical History

  • Are you willing to get a home group?*
  • Are you willing to get a sponsor?*
  • Are you willing to go to at least 4 meetings each week?*
  • Have you ever attended a 12 Step Meeting?*
  • Would you consider living in a recovery house?*
  • What is your drug of choice: (check all that apply)*
  • Method of use? (check all)*
  • Have you been recently incarcerated?*
  • Are you currently in a treatment facility?*
  • Are you planning on doing continued care (IOP/OP)*
  • Are you currently in a sober housing facility?*
  • Format: (000) 000-0000.
  • Do you have any other medical issues?*
  • Do you have any mental health issues?*
  • Do you currently take any medication(s)?*
  • Do you have a prescription for: (check all that apply)
  • Do you have a place to live?*
  • Was this living situation a safe & healthy environment?*
  • Do you have any pending legal charges?*

  • Long Answer Questions

    Personal History, Background, and Motivations - Please answer each question in detail. All For Recovery requires each question to be answered to its fullest in order to make an informed decision. Applications with unanswered questions or lacking in detail will not be considered. 

  • Expectations & Requirements
    of Grant Recipients     

     

    APPLICANTS:

    AFR requires certain measures be taken by our approved applicants. We believe these requirements will help you to stay in the middle of the program and achieve your longterm goal of sobriety.

    Each applicant will be assigned a Buddy from NA or AA. Your Buddy is in place to help you build your network of people in the program, and will help you stay in the middle of the program and not give up before the miracle happens.



    Requirements:

    • You must email/submit your weekly accountability worksheets to AFR on your assigned day.
    • You must check in with your buddy via phone at least 3 times a week. Your buddy will report back to AFR with your progress.
    • You must go to meetings at least 4 times a week.
    • You must have a sponsor within a week and it is recommended to raise your hand at a meeting and ask for a sponsor if you don’t already have a sponsor.
    • You must have a service position at one of your meetings.
    • You must have a home group.
    • You must be actively looking for a job.
    • Friend Kellie Plucinski on Facebook
    • Friend & Like AFR on social media.

    If all above requirements are met, we will be able to offer an additional 2 weeks grant for the rent at your facility.

     

    We encourage you to attend Kellie’s home group on Wednesday evenings at 8:30pm to meet Kellie and other AFR buddies and alumni for additional recovery support and cake. Olney Farms is located Salem United Methodist Church, 12 High St, Brookeville, MD 20833

     

    WAIVER 

    All for Recovery, Inc
    Authorization for Release of Confidential Information

  • Date
     - -

  • I,   *   * , Social Security Number:*, born on   Pick a Date*   authorize All for Recovery to: 
                *                                            
    Name of Agency:   *         Person of Contact:                
    Address: *   *   *   *   *      


    Applicant Contact Information: 
    Home Phone:         
    Cell Phone:      *   
    Email Address:    *   


    Relationship to Applicant:   *   

  • The following information:*
  • For the purpose of:*

  • I understand that my records are protected under Federal regulations, (42CFR, Part2), and the Health Insurance Portability Accountability Act (HIPAA), 45 C.F.R., pts 160 &164, and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also understand that I may revoke this consent at any time upon written notice, except to the extent that action has been taken in reliance on it, and that, in any event, this consent expires automatically one year from the date signed, otherwise unless specified below. I understand that generally All for Recovery may not condition my treatment on whether I sign a consent form, but that in certain limited circumstances support or collateral investigation is a key component and we may not be able to meet your needs without the key contacts involvement. I understand I am entitled to a copy of this document in its complete form. This authorization is valid (if not previously revoked) this consent will terminate upon 365 days from the date of signature of this form, or the following event/condition:   *, or the completion of treatment, or at the time of the final insurance billing, as the case may be, whichever is later.

  • Prohibition on Re-disclosure

    This information has been disclosed from records protected by Federal Confidentiality rules (42 CFR part 2). The Federal rules prohibit making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR part 2. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse client.

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