№ files_lp_4_process_3_125664
Structured community application form for Recovery Acres Edmonton collecting personal, medical, behavioral, and treatment history to assess eligibility and plan individualized support.
Year: 2025
Organization: Recovery Acres Society Edmonton
Document Type: Community application form
Target Audience: Individuals seeking support for substance use and behavioral addictions
Contact Information: Phone: (780) 471-2996, Fax: (780) 477-1578, Email: [email protected]
Required Information: Personal details, substance use history, medical and mental health history, treatment goals, support contacts
Program Participation: Previous clients, fellowships, recovery involvement
Eligibility Note: Applications not accepted from currently incarcerated individuals
End Date / Period: 2025
Format: Printable form for submission and interview scheduling
Internal Use: Notes, interview reminders, acceptance tracking
Application Components: Demographics, employment, housing, income, addictions history, behavioral concerns, medical history, treatment history, personal strengths and goals
Structured Fields: Yes, includes checkboxes, dates, and free-text responses
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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