Never Give Up Never Back Down - The Richard K. Urey Memorial Fund Grant for Addiction Recovery

Never Give Up, Never Back Down - The Richard K. Urey Memorial Fund

Never Give Up, Never Back Down - The Richard K. Urey Memorial Fund Grant for Addiction Recovery will support individuals desiring to stay at an Oxford House property in Delaware State or in Delaware County, PA for addiction recovery. Grant checks will be issued to the Oxford House to implement the grant request.
Name of the candidate for residency at Oxford House (this may be a self-nomination or a name put forward by an outreach worker at Oxford House):*

First NameLast Name
Name and address of Oxford House to be considered:
Does the candidate have permanent residency in the state of Delaware or in Delaware County, PA?*

YesNo
Does the candidate wish to stay in an Oxford House residency in either the state of Delaware or Delaware County, PA?*

YesNo
Does the candidate meet one of the following criteria?*

Recently incarceratedRecently discharged from an inpatient facility
Phone Number of the person wishing to stay at Oxford House:*

Area CodePhone Number
Email Address of the person wishing to stay at Oxford House:*
example@example.com
Most recent address of the person wishing to stay at Oxford House:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nominated by which Oxford House outreach worker (contact name):*

First NameLast Name
Email address of the outreach worker from Oxford House*
example@example.com
Phone Number of the outreach worker from Oxford House*

Area CodePhone Number
How many weeks will the candidate stay at Oxford House?*
Please describe the candidate's need and desire for recovery:*
Amount requested ($):*
Amount for move-in fee ($):*
Move in fee
Thank you for your inquiry, but your request does not fit within the geographical parameters of this grant.
Should be Empty:

Never Give Up, Never Back Down - The Richard K. Urey Memorial Fund