Live Rite Housing Scholarship

Emergency Contact Name Phone Number

###-###-####

Relationship Mother Father Spouse Sibling Son Daughter Grandfather Grandmother Grandchild Aunt Uncle Nephew Niece Friend Exspouse Employee Other Address Health & Recovery

Do you currently have health insurance?*

No Yes Carrier

Currently in Inpatient Facility?*

No Yes Drug(s) of Choice Clean Date

Are you on Medically Assisted Treatment?*

No Yes

Medication

Methadone Suboxone Vivitrol Shot Sublocade Antabuse Campral/Acamprosate Naltrexone Zubsolv Other

Do you have a peer recovery coach?*

No Yes Coach Name & Organization

Do you need a peer recovery coach?*

No Yes Pending Legal Issues

Parole/Probation/Family Court*

No Yes Office PO Phone Fax Crime/Issue Work and Income

Currently Employed?*

No Yes Employer Weekly Income

Do you have EBT?*

No Yes Application History

Have you or are you able to receive MCOSA funding?*

No Have Received Funding Able to Receive Funding

Have you applied for sober living funding from FAN in the past?*

No Yes

Are you applying for an extension of a current scholarship?*

No Yes

Have you applied for work since the first scholarship was approved?*

No Yes

Where have you applied for work in the past 30 days, list all
Have any resulted in an interview? If so, when and where?

What other resources have you applied to for funding? (DFAS, Churches, etc.) *

How did you hear about Live Rite Structured Recovery? Tell us why you are in need of a scholarship and how it will help your recovery journey House of Choice

You can view our houses on our Recovery Housing page. Make sure to select your gender & MAT status before making your housing choice.

1st Choice

Any Fraser St. Clair Shores Eastpointe Warren - Marshall Warren - Dexter Mt. Clemens Roseville MAT Roseville MAT

2nd Choice

Any Fraser St. Clair Shores Eastpointe Warren - Marshall Warren - Dexter Mt. Clemens Roseville MAT Roseville MAT