Fund Recovery Application for Funding
Our mission is to provide funding to directly support people struggling with addiction who cannot otherwise afford help, either by supporting the afflicted people directly or by supporting those who serve them. Please fill out the application to the best of your ability and we will be in contact with you soon. Thank you!
Sign in to Google to save your progress. Learn more
Full Name *
Today's Date *
MM
/
DD
/
YYYY
Name of current Treatment Program and duration of stay *
Name and cost of the Treatment Center for which you are applying.  If uncertain, please email us at team@fundrecovery.org. *
I have chosen a Fund Recovery approved provider. *
Total amount of money requested from Fund Recovery *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Fund Recovery.

Does this form look suspicious? Report