Date of Birth. (You must be 19 years of age or older)*
Would you like to see change in your life?*
Are you willing to commit to stay for the full length of the 6 month program?*
What is your current living situation?*
Addiction History & Information
Do you struggle with addiction(s)?*
Please select all that apply to you:*
What we offer as a part of our 6-month program:
Inner Healing (dealing with unresolved emotional pain - foundation of the program)
Housing
Employment Readiness Training
Life-Skills Development Classes
Personal Development
Spiritual Mentorship
Program Cost & Personal Income
$1800 a month + a one-time $350 damage deposit and $100 supplies fee. This excludes items such as personal groceries, transportation including cabs and bus fares, cigarettes and vapes, toiletries, personal items, etc.
List your primary source(s) of income and the amount received per month. Answer all that apply.
Do you have any outstanding debts?*
Do you have a financial aid worker?*
Will you have approved funding in place to pay for the program?*
Do you have any children?*
Is child protection currently involved with the family?
Please click "SUBMIT" and continue filling out the next form.
