Application for VA Recovery Housing Assistance

Are you a U.S. veteran or served in the National Guard/Reserves?

Yes

This application is only for veterans in need of help obtaining recovery housing. CLICK HERE to visit the application for all other individuals.

Are you seeking help with securing safe and stable recovery housing in South Carolina?

Yes

This application is only for veterans in need of help obtaining recovery housing. CLICK HERE to return to the Recovery page.

Hidden

Question 3

How did you hear about this application?(Required)

Outreach worker

Combined Arms platform

Therapist or case manager

Recovery housing provider or roommate

Mutual aid group (EXAMPLES: 12 Step, Celebrate Recovery)

Friend

Peer Support Specialist

Not listed above (Please describe)

If picked "Not listed above", please describe:

Hidden

Question 4

I am submitting this application for:(Required)

Myself

Someone else

If you are submitting for someone else:

What is your name?(Required)

First Last

What is your relationship to the applicant?(Required)

What is your phone number?(Required)

What is your email address?(Required)

Hidden

Question 5: Applicant Info Section

APPLICANT INFORMATION

Name(Required)

First Last

Phone(Required)

Email(Required)

Is the applicant a resident of South Carolina?(Required)

Yes

Unsure

Date of Birth(Required)

MM slash DD slash YYYY

Gender Identity(Required)

Man

Woman

Trans man

Trans woman

Genderqueer

Agender

Not listed above (Please describe)

If picked "Not listed above", please describe:

Sexual Orientation(Required)

Heterosexual

Lesbian

Gay

Bisexual

Pansexual

Asexual

Not listed above (Please describe)

If picked "Not listed above", please describe:

Race(Required)

Native American

Black/African American

White

Asian

Pacific Islander

Mixed Race

Not listed above (Please describe)

If picked "Not listed above", please describe:

Tribal Affiliation (Please enter "N/A" if no affiliation)(Required)

Ethnicity(Required)

Hispanic/Latino

Non-Hispanic/Non-Latino

Marital Status(Required)

Married

Divorced

Single

Widowed

Legally Separated

Has the applicant ever personally experienced any of the following? (Check all that apply)(Required)

Substance use issues

Mental health challenges

Trauma

Instituionalization

Criminal justice involvement

Foster care

Adoption

Homelessness

Unemployment

Please describe the applcant's substance use disorder(s). (Check all that apply)(Required)

Opioid Use Disorder (EXAMPLES: heroin, opioid medications)

Stimulant Use Disorder (EXAMPLES: meth, cocaine, Adderall)

Alcohol Use Disorder

Cannabis Use Disorder ( EXAMPLES: marijuana, THC extracts)

Other Type of Substance Use Disorder (Please describe)

If picked "Not listed above", please describe:

Has the Applicant been significantly impacted by a family member or friend who experienced any of the following? (Check all that apply)(Required)

Substance use issues

Mental health challenges

Trauma

Institutionalization

Criminal justice involvement

Foster care

Adoption

Homelessness

Unemployment

Treatment History – Has the Applicant received any of the following services to address substance use issues? (Check all that apply)(Required)

Emergency room

Medical detox

Residential treatment

Outpatient treatment

ADSAP

Counseling services

Recovery History – Has the Applicant received any of the following services to address substance use issues? (Check all that apply)(Required)

Mutual aid meetings (EXAMPLES: 12 Step, faith-based, All Recovery)

Recovery coaching

Recovery housing

Recovery community organizations (RCOs)

Peer support services (PSS)

Living Environment History – Where is the Applicant currently residing?(Required)

Jail/prison

Mental health institution (non-SUD primary diagnosis)

SUD treatment center

Staying with family or friends

Rented apartment/house

House/condo/townhouse that is owned by the Applicant

Currently experiencing homelessness

Not listed above (Please describe)

If picked "Not listed above", please describe:

Work History – Is the Applicant currently employed?(Required)

Yes

Hidden

Options A and B

Please enter the employment type – full time, part time, hourly, or salary.(Required)

Full Time

Part Time

Hourly

Salary

Please enter the Applicant’s gross monthly income.(Required)

Hidden

Options C and D

How long has the Applicant been unemployed?(Required)

Is the Applicant receiving unemployment benefits?(Required)

Yes

Hidden

Section Break

Does the Applicant receive any additional governmental assistance? (EXAMPLES: disability, SNAP, TANF)(Required)

Yes

Hidden

a: Types of Assistance and Monthly Amounts

Please list the type(s) of assistance and monthly amount(s).

Hidden

Section Break

Where is the Applicant in the process of moving into a recovery residence?(Required)

Not sure how to begin

Still searching

Has applied

Has been accepted

Has moved in

If the Applicant is currently residing in a recovery home or has applied to one or more, what type of home is it?(Required)

SCARR-certified program

What is the name of the house that the Applicant has applied to or been accepted to?

Please provide the name of the house/program you will be applying to. You may list up to three, as availability is fluid. (Please visit https://www.daodas.sc.gov/services/recovery/ to view all of the SCARR-certified programs in South Carolina. Also, please read the “Getting Started” document under the Recovery Housing Assistance tab for general information about choosing a recovery residence.

Untitled

Hidden

Consent Section

CONSENT(Required)

I agree

By submitting this form, I authorize DAODAS to inform the selected recovery residence(s) and SCARR representatives of my eligibility status and to request an invoice on my behalf (if applicable).

Application for VA Recovery Housing Assistance

Question 3

Question 4

Question 5: Applicant Info Section

APPLICANT INFORMATION

Options A and B

Options C and D

Section Break

a: Types of Assistance and Monthly Amounts

Section Break

Consent Section

Buprenorphine Locator

Local Treatment Providers

Hope Connects Survey