A scholarship foundation for people seeking recovery through sober living. Application Are you already in or have you been accepted to one of our Partners Homes? Yes No Are you currently still in treatment (detox, CSS, etc.) ? Yes No Will you be discharged within seven calendar days? Yes No We are sorry, but you must already be living at, or accepted to, one of our Partner Homes to qualify for a scholarship. Do not apply unless you will be discharged within seven calendar days. Your Gender(Required) Male Female This field is hidden when viewing the formPre-qualification part A - show question 1 is YesWhich Partner Home are you currently in or have been accepted into?(Required) Bennington House - Quincy, MA Cape Hope & Linda's Place - East Falmouth, MA Foundations Group - Mashpee, MA Hope Beyond Hope – Weymouth, MA LIV Recovery - Lowell, MA New Chapter Sober Living - Stoneham, MA Rise Above Sober Living - Lynn and Malden, MA Rosewood Sober Living - Braintree, MA Southern Mass Rest & Revive - Holbrook, MA Twin Lights Recovery - Gloucester, MA Next Chance Recovery - Falmouth, Pocasset, Sandwich, and Wareham The Megan House (Includes Erin's House and Emma's House) - Dracut and Lowell, MA Which Partner Home are you currently in or accepted into?(Required) Adult & Teen Challenge Massachusetts – Brockton MA Breaking Barriers – – Medford, Lynn, & Malden, MA Columbia House - Dorchester, MA Claude's House - Revere, MA Foundations Group - Mashpee, MA Integrity Sober Living - East Falmouth, MA Ocean House Recovery - Weymouth, MA Rosemary's House - Plymouth, MA South Shore Sober Living - Weymouth, MA The Will House - Beverly, MA Redemption House Proctor Farm - Danvers, MA Twin Lights Recovery - Gloucester, MA Who is your point of contact at the Partner Home?Point of Contact Name(Required)Name of your point of contact at the Partner HomePoint of Contact Phone(Required)Phone number of your point of contact at the Partner HomePoint of Contact Email(Required)Email address of your point of contact at the Partner Home Enter Email Confirm Email Are you able to pay for rent and monthly costs without our scholarship?(Required) Yes No We are sorry, but we only provide scholarships to those who cannot pay rent and monthly costs without our help.Application InformationName(Required) First Middle Last Have you ever been known by any other name?(Required) Yes No Please list any other names used / aliases(Required)click on the + to create more lines Add RemoveDate of Birth(Required) MM slash DD slash YYYY How did you hear about us?(Required) Google/Internet Curran's Calling Website I've Applied Before I've Received a Curran's Scholarship Before Friend Family Member Sponsor Recovery Center PHP/IOP Sober/Recovery Coach Case Manager Therapist AA/NA Meeting Other Contact InformationProvide a way for us to contact youPhone Number(Required)Whose Phone Number is this?(Required)Phone Type(Required) Mobile Landline Email(Required) Enter Email Confirm Email Conditions of ScholarshipAre you willing to do a phone interview with us?(Required) Yes No Do you agree to stay at our recovery partner home for at least 30 days and follow their rules?(Required) Yes No Do you agree to keep in touch/check in with us at least once a week while we are providing support?(Required) Yes No Do you agree to let us talk to your recovery home about your progress in recovery?(Required) Yes No Do you agree to sign a release with the recovery home staff allowing us to talk with them about your progress?(Required) Yes No Thank you for contacting us about our scholarships, but unfortunately, based on your responses, you do not meet our qualification requirements. If your circumstances change, we welcome you to connect with us at that time.DemographicsEthnicity/race(Required) Hispanic or Latino Not Hispanic or Latino Indicate one or more races(Required) American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White/Caucasian Other Highest level of education(Required) College High School GED Other Please describe education level(Required)Primary language(Required)Secondary language(Required)Enter "None" if you do no have a secondary languageAre you a veteran?(Required) Yes No Program DetailsAre you interested in a structured and/or faith-based program/spirituality based recovery house?(Required) Yes No Have you previously been part of this scholarship program?(Required) Yes No When(Required)For which house / recovery center(Required)Have you ever received any other scholarship before?(Required) Yes No List scholarships received during the past 6 months(Required)Your current living situationMedical Facility or Detox?(Required) Yes No Program Name(Required)Clinician Name(Required)Private Home?(Required) Yes No Whose home is this?(Required)Another Sober Living Home / Recovery Center?(Required) Yes No Facility Name(Required)Location(Required)Primary Point of Contact(Required)Substance use historyWhat are your drug(s) of choice?(Required) Alcohol Inhalants (e.g. paint thinners, glue) Heroin Fentanyl Marijuana (e.g. pot, weed) Hallucinogens (e.g. LSD, mushrooms) Over-the-Counter Medications (e.g. cough suppressants) Opioids (e.g., morphine, oxycodone, Percocet, Percodan, and Roxicodone, Vicodin, Lortab, Lorcet) Benzodiazepines (e.g., Valium, Xanax, Klonopin, Ambien) Stimulants (e.g., Adderall, Ritalin, “bennies, "black beauties," and "speed") Methamphetamines Cocaine/Crack Other Other drug(s) of choice:When was your last use of any mind- or mood-altering substance?(Required)This includes prescription medications, and replacement therapy such as buprenorphine and methadone.When was your last use of alcohol?(Required)Addictive behaviorsDo you identify patterns or other areas in your life that you may have addiction qualities?(Required) Yes No Please explain patterns or other areas in your life that you may have addiction qualities(Required)Do you gamble or have other addictive behaviors?(Required) Yes No Please explain your gambling or other addictive behaviors(Required)TreatmentAre you currently in, or have you been in, any kind of treatment in the past 90 days?(Required) Yes No Please explain the treatment(Required)Do you have a case manager?(Required) Yes No Please provide the case manager's name and contact number(Required)Have you ever attended any type of treatment program? This includes detox, halfway houses, sober houses, outpatient and partial hospitalization programs.(Required)These are programs attended prior to the past 90 days. Yes No Please provide details about all the programs you have attended prior to the past 90 days(Required)Do you have a sponsor?(Required) Yes No Do you have a recovery coach?(Required) Yes No Assistance NeededAre you currently employed?(Required) Yes No Describe you employment (e.g. full-time/part-time etc)(Required)What are currently doing to seek employment?(Required)If you have any immediate needs such as clothing or toiletries, please list what you need.Use the + on the right to create more lines. Add RemoveDo you need assistance with finding self-help groups or accessing outside help such as therapy, and/or any other resources in the community to aid in your recovery? If so, please let us know how we can help.Do you need health insurance?(Required) Yes No Do you need access to local food programs?(Required) Yes No AdmissionsWhen would you like to move in?If you have a personal relationship with anyone that works at our partnered recovery homes please provide their name and the home they are associated withIf you have a personal relationship with anyone working with our Foundation or on it’s Board of Trustees please provide their nameIf you have previously applied to or attended any of our partner recovery programs please tell us which onesHow long do you plan to stay in treatmentPlease explain if there any obstacles that would stop you from completing the programI have read and agree to the Disclaimer Statement(Required)I acknowledge and understand that the scholarship awarded to me will only be disbursed directly to the recovery home to which I am admitted. I further acknowledge that Curran’s Calling is not involved in any admissions or retention decisions to any sober living home. I understand that I am solely responsible for meeting admission and retention criteria into any recovery home receiving scholarship funds on my behalf. I understand that Curran’s Calling does not participate in any way in the operations of any sober living house and I agree to hold Curran’s Calling harmless and its respective officers, representatives, agents, servants, employees, successors and assigns from and against any and all claims, demands, suits or other forms of liability that may arise out of my participation in this scholarship program and/or my participation in any sober living home receiving funds on my behalf. Yes No
