Steps To Freedom Application
Thank you for applying to Aaqitauviks’ Steps to Freedom Program. This is an approximate 3 week program, with sessions focusing on healing from past trauma, wounding and resulting addictions.
**EACH APPLICANT IS RESPONSIBLE TO ARRANGE AND PROVIDE THEIR OWN FLIGHT, HOUSING AND FINANCIAL NEEDS WHILE THEY ARE STAYING IN QUAQTAQ FOR THE PROGRAM. **HOUSING MUST BE ARRANGED AND CONFIRMED BY THE HOMEOWNER TO THE AAQITAUVIK OFFICE BY PHONE OR EMAIL, BEFORE AN ACCEPTANCE LETTER WILL BE ISSUED.
During this time, you will attend each session Monday-Friday, where daily attendance will be taken. A general report will be given to the Lawyer or Social Services where necessary.
**REQUIRED. PLEASE ATTACH A SHORT LETTER ABOUT YOURSELF AND WHY YOU WOULD LIKE TO ATTEND THE STEPS TO FREEDOM PROGRAM.
If you have further questions, you can contact our office at 819-492-9145 or email us at manager@aaqitauvik.ca
Registrant
Location:
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Dates:
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Name of Registrant:
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Number & Street Name or PO Box:
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Community:
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Province:
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Postal Code:
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Cell or Phone:
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Please enter a valid phone number.
Email:
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Date Of Birth:
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Gender:
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Marital Status:
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Single
Married
Separated
Divorced
Lawyer/Social Worker
Name of Contact for Lawyer or Social Worker's Name:
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Contact Email:
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Contact Phone Number:
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Please enter a valid phone number.
Reason for Incarceration:
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I understand and agree that there will be group pictures taken during the program. I give my permission that any photo with my picture in it can be used in promotional purposes for Aaqitauvik Healing Centre
Click here:
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Agree
Do Not Agree
Address During Program
Homeowner:
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Number & Street Name or PO Box:
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Community:
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Phone # of Homeowner:
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Please enter a valid phone number.
Emergency Contact
Name:
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Relationship to You:
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Day Phone Number:
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Please enter a valid phone number.
Night Phone Number:
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Please enter a valid phone number.
Please verify that you are human
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