Scholarship Aid for Alcohol and
Drug Abuse Treatment

St. Joseph Institute provides scholarships to assist those seeking alcohol and drug abuse treatment. Scholarships range in size from $2500 to $8,000 and are based on financial need. Please complete the form below and we will quickly calculate the scholarship available to help cover the cost of receiving alcohol and drug abuse treatment. Scholarships are not available to individuals who have health insurance that is accepted by St. Joseph Institute. All financial assistance is applied toward the cost of treatment.

If you would prefer to download a PDF version of this application please click here.
Name of the person seeking treatment?
  A value is required.*
Occupation
 
Place of Employment
 
(If currently unemployed, please indicate this in the field above.)
Please provide your general contact information below.
Telephone: A value is required.*
Email Address: A value is required.*
Zip Code:
Name(s) of wage earner(s) in household:
 
Number of family members at home:
  A value is required.*
Combined Annual Income:
  A value is required.*
(Note – Further documentation may be necessary to confirm information provided.)
Additional information that you would like us to consider (such as a financial hardship or other circumstances).
 
You must certify that the information provided above is accurate.
  You must certify the accuracy of this form! Yes, the information contained above is both accurate and complete. I understand that falsification of this information may result in the loss of any scholarship aid.

Please note that required fields are indicated with an asterisk (*).

 

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(888) 777-1098
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