Scholarship Application

516 Light Foundation Sober Home Scholarship Application

516 Light Foundation welcomes you to the Sober Living (Recovery Housing) scholarship application.

The information you provide is confidential and will NEVER be shared or sold unless the recipient gives explicit consent.

We prioritize working diligently to respond to your requests and provide you with assistance. We understand that this may be a stressful time, and we recognize that this application asks about sensitive topics. We need you to know that we care for you and hope to help you. The Board of the 516 Light Foundation is made up of volunteers and are likely to take a week or two to reply to your request. If you feel like you are in a crisis and need immediate support, call The National Suicide Prevention Lifeline at 1-800-273-8255.

We are grateful for your participation and wish you all the best. Please be advised duplicates applications (those who have already received a 516 Sober Home scholarship) and unfilled questions will be automatically rejected.

By submitting this scholarship application form to 516 Light Foundation you are granting 516 Light Foundation permission to:

a) use your answers in a de-identified data set (your name, recovery home address, phone number, email address, won't be included) for research analyses.

b) contact the provided recovery residence directly.

c) contact you as the recipient for follow up.

Do you understand and agree to have your application included in this data set and for 516 Light Foundation to reach out to contact your recovery home directly?*

YesNo

What is today's date:*

What is your first name and last name?*

What is your email address?*

Please confirm your email address:*

What is the best phone number for you?*

What is your date of birth?*

Which of the following most closely aligns with your racial identity? (select all that apply)*

How would you describe your gender identity?*

Are you currently working or in school? (select all that apply)*

IF OTHER work/school, please specify:

Have you served in the military?*

YesNo

What is your highest level of education?*

What is your religion? (select all that apply)*

If OTHER Religion, please specify:

What is your current relationship status?*

Married or living with someone as if marriedNon-cohabitating relationship (in a relationship but we do not live together)SingleDivorced or Separated">Divorced or SeparatedLoss of long-term partner or WidowedPrefer not to answer

Are you entering recovery from any of the following settings? (Select all that apply)*

Which of these categories best describes your total combined family income for the past 12 months?*

Are you covered by health insurance? (Check all that apply)*

If OTHER health insurance, please specify:

What are the primary substance(s) that brought you to your desire for recovery? (Please check all that apply)*

Other (Please specify)

Do you live in recovery housing now?*

YesNo

When did you move into your recovery home? (Select one option)*

What is your confirmed move-in date for your recovery home?*

Have you ever lived in a recovery house (also known as sober living) or other recovery-based residence before?*

YesNo

If yes, how many times?

What was your longest length of stay?*

Will (or are) any of your child(ren) staying with you in your recovery home?*

*Your response to this question is optional and will not be part of determining whether you are awarded a scholarship. We are interested in understanding the unique needs of people in recovery who have children so that we are able to think about ways to support people in this situation.

YesNoI don’t have childrenPrefer not to answer

If at least one of your children will be coming with you to recovery housing, please list the age(s) of each child that will be coming with you.*

516 Light Foundation will reach out to your named recovery home to confirm that you are scheduled to move in or are currently residing there, and if you are selected to receive a scholarship, to organize payment.

Applicants must provide a professional email address for the recovery home contact person in their application. If the applicant includes their own email address (or another personal email address), in place of a staff member/elected officer contact person, they will not be eligible to receive a scholarship. If a person does not know the correct email address for a staff person/elected officer at their recovery home yet, they should not proceed with the application.

Please provide your recovery home staff contact information (or elected officer if at an Oxford House) below:

Name of your recovery home*

Name of a staff contact person (or elected officer if you're at an Oxford Home) at your recovery home*

Professional email address of staff contact person/elected OH officer listed above*

Phone number of your recovery home, including area code*

Mailing address of your recovery home*

City and State where your recovery home is located*

Zip Code where your recovery home is located*

What is your monthly rent amount at the recovery home you will be moving into?*

Use this part of the application to see how much money you spend in a month. Then, use this month’s information to help you plan next month’s budget.

Month*

Year*

My income this month

Income	Monthly Total
Paychecks (salary after taxes, benefits, and check cashing fees)*
Other income (after taxes) for example: child support*
Total monthly income*

My expenses this month

Expenses Monthly total

Income	Monthly Total
HOUSING
Rent or mortgage*
Renter's insurance or homeowner's insurance*
Utilities (like electricity and gas)*
Internet, cable, and phones *
Other housing expenses (like property taxes)*
FOOD
Groceries and household supplies*
Meals out*
Other food expenses*
TRANSPORTATION
Public transportation and taxis*
Gas for car*
Parking and tolls*
Car maintenance (like oil changes)*
Car insurance*
Car loan *
Other transportation expenses*
HEALTH
Medicine*
Health insurance*
Other health expenses (like doctors' appointments and eyeglasses)*
PERSONAL AND FAMILY
Child care*
Child support*
Money given or sent to family*
Clothing and shoes*
Laundry*
Donations*
Entertainment (like movies and amusement parks)*
Other personal or family expenses (like beauty care)*
Fees for cashier's checks and money transfers*
Prepaid cards and phone cards *
Bank or credit card fees*
Other fees*
OTHER
School costs (like supplies, tuition, student loans)*
Other payments (like credit cards and savings)*
Other expenses this month*
Total monthly expenses*

Maybe your income is more than your expenses. You have money left to save or spend.

Maybe your expenses are more than your income. Look at your budget to find expenses to cut.

The following statements are related to the factors that are part of recovery, both internal to you and also external. They are called "Recovery Capital." Like addiction, recovery has components that are mental, physical, social, cultural and so much more. Please click if you agree/disagree with the following statements: