Apply for Support

Financial Aid

Offering financial aid to assist families with treatment and intervention, striving to remove potential financial barriers in finding recovery.

Scholarship Bed Policy & Procedure

Name (required)

First Name (required)

Last Name (required)

Phone (required)

Email (required)

Please be assured that none of these questions are intended to disqualify you. They are simply meant to help us better understand how we can best support you and your loved one. Our goal is to provide comprehensive and effective services to assist you and your family throughout the entire recovery process.

Are you in search of support for Intervention services or treatment services for your loved one? (required)

Regarding treatment, are you or your loved one: (required)

Are you involved in our family support program? (required)

If answer to question above is "No", are you willing to commit to 4 months of family programming with The Family Recovery Foundation? (required)

Who are you seeking support for? (required)

If for a family member, have they ever received treatment before? If so, did they participate in aftercare? Did they discharge successfully? (required)

Have they ever AMA'd (left against medical advice) from treatment? (required)

Have you, if a family member, ever participated in recovery for yourself? (required)

Are you aware of any mental health diagnosis? If so, please explain. If not, mark N/A. (required)

Are you seeking: (required)

To assess your needs, we may need to collect protected health information (PHI) from you. This form is not HIPAA compliant and information is transmitted via encrypted email. By submitting, you acknowledge and understand these terms.