Survivor Application
Dear Friend,
Thank you for reaching out to ARI, we are excited to see the ashes of your past become beauty for your future (Isaiah 61:1-3). Each application is reviewed and goes through a scholarship committee that meets once a month. We appreciate your patience in reviewing your application. Before images of what needs to be removed/covered must be sent in with your application-- applications.ari@gmail.com. YOU ARE IN A SAFE PLACE- no one will see these images outside of ARI without your consent.
Eligibility Requirements:
• Tattoo or scar must be related to the categories in the box below- no exceptions.
• You must be involved in some form of recovery, addiction treatment or safety program for at least six months but preferably one year. You must be self harm free for one year (due to scarring), IF you are currently in a program, counseling, or in treatment a letter of referral is requested from a counselor, pastor, case worker, law enforcement agency or program director)

HOTLINES (If you are in immediate danger call 911)
Human Trafficking Hotline: 1-888-373-7888 Mental Health/Suicide Hotline: 1-800-273-8255
Self Harm Support Line: 1-800-DON'TCUT (366-8288) Domestic Violence Hotline 1800-799-7233

Today's Date *
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Name (first, last) *
Your answer
Birth date *
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Address (including city/state) *
Your answer
Phone *
Your answer
Text OK? *
E-mail *
Your answer
Referred by (program, online, counselor, church, other) *
Your answer
Service Need *
Please tell us why you are seeking a removal or restoration cover (We only cover/remove the following) *
Tell us your story (how this mark was obtained, where you are in life now, how are you walking out your recovery ) *
Your answer
Are you actively seeking help/assistance in your recovery? (counseling, church support, program, etc) *
If you answered yes- please provide type
Your answer
If You answered NO- do you need resources *
Your answer
How will this removal or cover impact your future? *
Your answer
Date You started your healing process *
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Location of markings *
Your answer
What steps are you taking in your recovery and what are you doing to make these goals/dreams possible? *
Your answer
Pertaining to Self Harm- Have you had tattoos after your self harm recovery?
Your answer
When did you get your last tattoo or tattoo removal *
Your answer
Did you email your before photo of what is needing to be removed/covered? (required to send for applicants --- application.ari@gmail.com *
Required
By checking the box below to submit this application, you AGREE to the terms below. 1. A valid state ID is required. If you are a minor a parent or guardian must be present for your appointment. 2. We are a faith based organization, no covers will be approved that depict death, demons, matching/similar boyfriend tattoos, witchcraft, astrology/mythology, horror imagery, depressive images or anything that conflicts with the mission of ARI. Covers cannot be significantly larger than what is being covered. 3. ALL applications go through a review board and are selected upon following guidelines, funding or availability. 4. Failure to communicate with ARI will delay your application. 5. Once approved - No shows, disrespecting shops, providers donated time or ARI representatives will terminate your appointment. 6. ARI and Providers reserve the right to terminate the appointment at any time for violating these guidelines. Pertaining to self-harmers- You must be self-harm free a year or more before having scars covered and active in your recovery. *
Required
Did you read the full disclosure above, entirely? *
For Residential Programs: By checking below you agree that you will not use ARI's mission for profit. You also agree that even if a resident leaves your program you will pass along our info to them as this opportunity is not a "reward" its part of their healing process. *
Required
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