Apply for a Scholarship to Assist with Detox or Rehab

The cost of treatment might seem out of reach.  Even with health insurance, there are still unforeseen expenses such as co-pays and travel.  Simply call the number or complete the form below and a Foundation Liaison will assist you with the scholarship process.


Scholarship Application Form

    Your Name (required)

    Email Address (required)

    Phone Number (required)

    Date of Birth




    Zip Code

    Applicant’s Parent/Guardian(s) Name

    Total Household *Income (including wages)

    Number of Household Members

    Do You Have Health Insurance?

    If Yes, Name of Insurance Company

    Do You Have Any Other Health Coverage?

    If Yes, Please Explain

    Did You Graduate High School?

    Have You Ever Been To Treatment Before?

    Letter of Recommendation:
    A letter of recommendation must be submitted for each applicant. The letter should attest to the applicant’s character and citizenship qualities.


    Each applicant must submit a type written essay that discusses the theme of:

    “How will my education and training assist me to make a difference in the field of addiction and the recovery community”

    Describe how you will make a positive contribution to the field of addiction. Give a specific example on how recovery from drugs and alcohol makes a difference in the life of the individual and their family.

    Please note that this is an application only.  A Foundation Liaison will work with you to help process the application and present it to the deciding Board.