Apply to the Breaking Addiction Scholarship

Breaking Addiction Application

To apply for the breaking addiction scholarship program, please fill out the following form. The first page consists of your personal contact and patient information. The second page is for your application story.
1 Step 1 - Personal Application
2 Step 2 - Application Essay
  • We will let you know when your story is live on the website!
  • Tell us the basics. How long, on what, and why seek treatment?
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