MVPASAP Scholarship Request

COMMUNITY PREVENTION COLLABORATIVE

Sober Living Scholarship Application

Helping individuals build a foundation for recovery, stability, and independence.

1. SCHOLARSHIP REQUEST

Amount Requested: $

Date of Application:

Date You Expect to Move In:

Length of Stay Anticipated:

Reason for Request:

2. SOBER LIVING INFORMATION

Sober Home Name

Sober Home Address

City, State, Zip Code

Manager's Name:

Manager's Phone:

Manager's Email:

Has the sober home accepted you?

Yes No

Is the sober home MASH-Certified/Approved?

Yes No

May MVPASAP verify your residency and scholarship request with the sober home?

Yes No

3. RECIPIENT INFORMATION

Full Name

Telephone

Recipient Address

City, State, Zip

Employer (if applicable)

Monthly Income: $

Other Income/Assistance (if applicable): $

Are you currently attending school?

Yes No

School/Program (If applicable)

4. RECOVERY & SUPPORT

Current Sobriety Date

Date of Most Recent Treatment

Treatment Facility/Program

Did you successfully complete treatment?

Yes No

Name of Recovery Support Person

Phone/Email

Are you currently attending recovery meetings?

Yes No

Type/Frequency of Meetings:

5. FINANCIAL NEED

Monthly Sober Living Rent: $

Amount You Can Currently Contribute: $

Amount Requested from MVPASAP: $

Are you receiving financial assistance from another organization?

Yes No

If yes, from whom and how much?:

What is preventing you from paying the full cost of sober living at this time?

6. YOUR RECOVERY JOURNEY

Please tell us in your own words, why why you are seeking sober living and how this scholarship would help you move forward in your recovery.

What are your goals for the next 90 days?

What is your plan to become financially self-sufficient and maintain your recovery?

7. PREVIOUS MVPASAP ASSISTANCE

Have you previously applied for a scholarship with MVPASAP?

Yes No

If yes, when?

If yes, what was the outcome?

8. RECIPIENT COMMITMENT

If awarded a scholarship, I agree to:

Provide MVPASAP with a brief monthly update for one year regarding my recovery, employment, education, and overall progress.

Maintain communication with MVPASAP regarding significant changes that may affect my recovery or housing.

Notify MVPASAP if I experience a relapse or leave the sober living program, so that appropriate support and resources may be offered.

Participate in two MVPASAP community events or volunteer opportunities during the scholarship year, when reasonably able.

Continue working toward my personal recovery, employment, education, and financial stability goals.

Understand that scholarship funds are intended to support sober living and may be paid directly to the sober living residence.

Understand that receiving this scholarship does not guarantee additional financial assistance from MVPASAP.

9. CERTIFICATION & SIGNATURE

I certify that the information provided in this application is true and accurate to the best of my knowledge . I understand that MVPASAP may veify information necessary to evaluate this request. I understand that scholarship funds are intended to support sober living and recovery-related stability.

Date

MVPASAP Scholarship Request

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