Recovery Starts Here.

Full Recovery Is Possible.

Need Confidential Assistance for Yourself or a Loved One?

If you are struggling with Substance Use Disorder and are willing to begin a recovery journey with the help of Inservice Foundation, please fill out this application or contact us directly at carli@inservicefoundation.org. We will be in touch with you as soon as possible.

First Name *

Last Name *

Email *

Phone *

Where do you currently live? *

Living situation (own, rent, please explain): *

I am currently: *

Current source of income: *

What brought you here? *

Are you currently "using"? *

Please share frequency, usage and chosen substances. *

Have you ever been in any recovery programs? *

Additional recovery programs:

Please describe your journey to recovery up to this point:

What do you see yourself needing the most help with? *

To be considered as a a beneficiary for recovery funding from Inservice Foundation, you must verify the following: I have reviewed the Terms & Conditions and Privacy Policy. *

Yes

If I am selected to receive funding and/or care from Inservice Foundation, I am willing to remain abstinent/sober throughout the duration of my recovery plan with Inservice Foundation or may be subject to expulsion from all funding and care. *

Yes

I am over 18 years of age. *

Yes

I am prepared to provide verification of financial need. *

Yes

My liquid net worth is less than $100,000 (e.g. cash, .money market accounts, checking accounts, savings accounts, stocks, trusts, mutual funds, bonds and any other securities). *

Yes

I am able to provide emergency contact information. *

Yes

I consent to a criminal background check if I am selected for an interview. *

Yes

I learned about Inservice Foundation from:

I understand that this application is in no way an offer or a guarantee of an offer for financial assistance, or other support, from Inservice Foundation. At no time does completion of this application construe or otherwise form a contractual relationship or agreement between Applicant and Inservice Foundation. *

Yes

Is there any additional information we should know? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Your application will be handled with care. All information will be maintained and used pursuant with the Inservice Foundation privacy policies, including, but not limited to, with whom your information is shared and how your information is stored.

Should we require additional information, an Inservice Foundation representative will be in touch.

Inservice Foundation application and interview process:

Individuals in need must complete the full application.
Inservice Foundation will review all fully complete applications.
Applicants selected for an initial screening interview will be notified and and set up an initial screening interview explaining how funding works and all terms and conditions will be arranged.
Applicants who are not selected for an initial screening interview will be notified of this decision.
If the applicant appears to be a candidate, after the initial screening interview, a formal interview will be arranged via Zoom.
This interview allows the team to understand the type of support that is needed and the level of financial assistance required.
The team will also be assessing the willingness of the individual to comply with all clinical recommendations should assistance be granted.
Beneficiaries will be notified of acceptance/denial via email within 1-2 weeks of the formal interview.

Email Address

Terms & Conditions

Privacy Policy