Apply – Pelican Intervention Fund

Fields marked with an * are required

Requirements to apply

To apply for funding from the Pelican Intervention Fund, applicants must be at least 18 years of age.

Please note: to receive funding you must first complete detox and a 2+ week transitional program.

Date of Birth *

First Name *

Last Name *

Gender *

Mailing Address *

City *

State *

Zip Code *

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Other Requirements

Applicants must also have:

Completed detox
Completed a 30 day transitional program
Significant financial need
Willingness to commit to an extended stay at a structured 12-step based sober living residency in one of the homes we fund

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Name of Detox Facility *

Date Admitted *

Date Discharged

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Name of Transitional Program Attended

Date Admitted

Date Program Completed

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In one or two sentences describe your financial need and list any sources of funding *

180 of 180 character(s) left

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Phone *

Email *

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