Application for Recovery Housing Assistance

Please use this form to apply for financial assistance in obtaining stable recovery housing.

Apply for Recovery Housing Assistance

Recovery Housing

Are you seeking help with securing safe and stable recovery housing in South Carolina?

Yes

THIS APPLICATION IS ONLY FOR PEOPLE IN NEED OF HELP WITH OBTAINING RECOVERY HOUSING. CLICK HERE TO RETURN TO THE RECOVERY PAGE

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Question 2

How did you hear about this application?(Required)

Therapist or Case Manager

Recovery housing provider or roommate

Mutual aid group (EXAMPLES: 12 Step, Celebrate Recovery)

Friend

Peer Support Specialist

Not listed above (Please describe)

If picked "Not listed above", please describe:

I am submitting this application for:(Required)

Myself

Someone else

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Applying for someone else section

If you are submitting for someone else:

What is your name?(Required)

First Last

What is your relationship to the applicant?(Required)

What is your phone number?(Required)

What is your email address?(Required)

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Applicant Info Section

APPLICANT INFORMATION

Name(Required)

First Last

Phone(Required)

Email(Required)

Is the applicant a resident of South Carolina?(Required)

Yes

Unsure

Date of Birth(Required)

Gender Identity(Required)

Man

Woman

Trans man

Trans woman

Genderqueer

Agender

Not listed above (Please describe)

If picked "Not listed above", please describe:

Sexual Orientation(Required)

Heterosexual

Lesbian

Gay

Bisexual

Pansexual

Asexual

Not listed above (Please describe)

If picked "Not listed above", please describe:

Race(Required)

Native American

Black/African American

White

Asian

Pacific Islander

Mixed Race

Not listed above (Please describe)

If picked "Not listed above", please describe:

Tribal Affiliation (Please enter "N/A" if no affiliation)(Required)

Is the applicant a U.S. veteran or served in the National Guard/Reserves?(Required)

Yes

Ethnicity(Required)

Hispanic/Latino

Non-Hispanic/Non-Latino

Marital Status(Required)

Has the applicant ever personally experienced any of the following? (Check all that apply)(Required)

Substance use issues

Mental health challenges

Trauma

Instituionalization

Criminal justice involvement

Foster care

Adoption

Homelessness

Unemployment

Please describe the applcant's substance use disorder(s). (Check all that apply)(Required)

Opioid Use Disorder (EXAMPLES: heroin, opioid medications)

Stimulant Use Disorder (EXAMPLES: meth, cocaine, Adderall)

Alcohol Use Disorder

Cannabis Use Disorder ( EXAMPLES: marijuana, THC extracts)

Other Type of Substance Use Disorder (Please describe)

If picked "Not listed above", please describe:

Has the Applicant been significantly impacted by a family member or friend who experienced any of the following? (Check all that apply)(Required)

Substance use issues

Mental health challenges

Trauma

Instituionalization

Criminal justice involvement

Foster care

Adoption

Homelessness

Unemployment

Treatment History – Has the Applicant received any of the following services to address substance use issues? (Check all that apply)(Required)

Emergency room

Medical detox

Residential treatment

Outpatient treatment

ADSAP

Counseling services

Recovery History – Has the Applicant received any of the following services to address substance use issues? (Check all that apply)(Required)

Mutual aid meetings (EXAMPLES: 12 Step, faith-based, All Recovery)

Recovery coaching

Recovery housing

Recovery community organizations (RCOs)

Peer support services (PSS)

Living Environment History – Where is the Applicant currently residing?(Required)

Jail/prison

Mental health institution (non-SUD primary diagnosis)

SUD treatment center

Staying with family or friends

Rented apartment/house

House/condo/townhouse that is owned by the Applicant

Currently experiencing homelessness

Not listed above (Please describe)

If picked "Not listed above", please describe:

Work History – Is the Applicant currently employed?(Required)

Yes

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Options A and B

Please enter the employment type – full time, part time, hourly, or salary.(Required)

Full Time

Part Time

Hourly

Salary

Please enter the Applicant’s gross monthly income.(Required)

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Options C and D

How long has the Applicant been unemployed?(Required)

Is the Applicant receiving unemployment benefits?(Required)

Yes

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Does the Applicant receive any additional governmental assistance? (EXAMPLES: disability, SNAP, TANF)(Required)

Yes

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Types of Assistance and Monthly Amounts

Please list the type(s) of assistance and monthly amount(s).

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Where is the Applicant in the process of moving into a recovery residence?(Required)

Not sure how to begin

Still searching

Has applied

Has been accepted

Has moved in

If the Applicant is currently residing in a recovery home or has applied to one or more, what type of home is it?

Oxford House

SCARR-certified program

What is the name of the house that the Applicant has applied to or been accepted to?

Please provide the name of the house/program you will be applying to. You may list up to three, as availability is fluid. (Please visit https://www.daodas.sc.gov/services/recovery/ to view all of the Oxford House locations as well as all of the SCARR-certified programs in South Carolina. Also, please read the “Getting Started” document under the Recovery Housing Assistance tab for general information about choosing a recovery residence.

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Application for Recovery Housing Assistance

Apply for Recovery Housing Assistance

Recovery Housing

Question 2

Applying for someone else section

Applicant Info Section

APPLICANT INFORMATION

Options A and B

Options C and D

Section Break

Types of Assistance and Monthly Amounts

Section Break

Consent Section

Buprenorphine Locator

Local Treatment Providers

Hope Connects Survey