Treatment Scholarships

The Parents Supporting Parents Memorial Scholarship program awards admission funds for people seeking substance abuse treatment. Scholarships are awarded to one of our selected group of structured sober living homes within the Massachusetts and New Hampshire area. All applicants must reside in Barnstable County (or have a parent, grandparent, or legal guardian reside in the county).

The scholarship programs are awarded to defray the cost of sober living for people coming directly from a treatment facility where they have been deemed ready for sober living by their treatment counselor/manager.

Name

Home Town

Phone

Best Way To Contact You

Birth Date

Discharge Date

Barnstable County Resident

Yes No

Detox/Rehab Facility

Not a resident?

Case Manager Name

Name/Location of Sober House

Case Manager Email Address

Email Address of Sober House

Case Manager Phone Number

Why do you need financial assistance?

Medications

Explain why you should be considered for a PSP Scholarship; and your level of motivation for maintaining sobriety.

Have you received a PSP scholarship before?

Yes No

If you receive a scholarship are you willing to stay in touch with PSP?

Yes No

I agree for my clinician to release information to PSP

Yes No

I downloaded and completed the release form

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Name

Home Town

Phone

Best Way To Contact You

Birth Date

Barnstable County Resident

Yes No

Not a resident?

Discharge Date

Detox/Rehab Facility

Case Manager Name

Case Manager Email Address

Case Manager Phone Number

Name

Address

City/State/Zip

House Manger Name

House Manager Email

House Manager phone

Why do you need financial assistance?

Explain why you should be considered for a PSP Scholarship; and your level of motivation for maintaining sobriety.

Have you received a PSP scholarship before?

Yes No

If you receive a scholarship are you willing to stay in touch with PSP?

Yes No

I agree for my clinician to release information to PSP

Yes No

Print Name of Applicant

Date of Birth

Cell Phone

Sober Home Name

Manager at Sober Home

Manager Phone

Manager email

Sober Home Address

Signature