Services Residential Treatment

Request for Admission

If you're considering applying to the 6-Month Residential Treatment program, we applaud you for making it this far. This is a very vital step in finding lasting freedom through sobriety. If you're ready to say "yes" to receiving the help and support Rising Above Ministry has to offer, please fill out the below application and make sure to call us to ensure your application has been received.

If you prefer to send in your application by fax, please click here and you will be redirected to the admission download page.

*Denotes Required Field
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NO SUBOXONE OR METHADONE PERMITTED IN PROGRAM

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PLEASE CHECK ALL THAT APPLY AND INDICATE SINCE WHEN

What we offer as part of our 6-month program:

  • Inner Healing (dealing with unresolved emotional pain - foundation of program)

  • Housing

  • Employment Readiness Training 

  • Life-Skills Classes

  • Personal Development 

  • Spiritual Mentorship 

List your primary source(s) of income and amount received per month. Check all that apply.

FAMILY/SOCIAL NETWORK

If yes, please complete the boxes below.

MENTAL HEALTH STATUS AND COGNITIVE CONCERNS

Please select any diagnosed mental health disorders that apply to you.

LEGAL HISTORY

PLEASE SEND A COPY OF ANY AND ALL CHARGES TO APPLY@RISINGABOVEGP.COM

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CLEAN TIME REQUIREMENT 

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CONSENT FOR RELEASE OF INFORMATION TO RISING ABOVE

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