Addiction Treatment Services Scholarship for Recovery

Include all recipient information. If you are applying for this on behalf of someone, please include it in the notes section at the bottom of the application. Only clients at Addiction Treatment Services are eligible and scholarships will be awarded based on need as determined by our executive team. If you have any questions, please let us know: info@addictiontreatmentservices.org.

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* 1. First & Last Name

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* 2. Date of Birth (DD/MM/YEAR)

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* 3. Home Address

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* 4. Email & Phone Number (for confirmation + announcements)

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* 5. Are you currently enrolled in a program with ATS?

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* 6. Current Employer & Title

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* 7. Insurance Provider

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* 8. Reference Name, Phone Number & Email (Someone who can vouch for you and your recovery journey)

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* 9. How long have you been dealing with Substance Use Disorder?

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* 10. Tell us about your SUD treatment progress:

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* 11. What does recovery mean to you?

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* 12. Why do you need this scholarship?

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* 13. What program are you in at ATS?

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* 14. What other scholarships or funding have you received?

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* 15. Amount requested and why:

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* 16. How will this funding impact your recovery plan and your recovery goals?

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* 17. What will your recovery plan be during and after this service?

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* 18. Are you willing to share pieces of your story and how you utilized the funding?

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* 19. Any notes or comments you wish to include:

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