Gratitude Retreat Foundation
empowering newly recovering alcoholics
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Request for New Resident Funding
Today's Date
Facility Name
*
Facility Contact Person / Representative
*
Facility Contact Phone Number
*
Facility Contact Email
*
Sober Applicant Name
*
Starting Bed Date
*
Ending Bed Date
*
Include any special requests here. PLEASE NOTE: If your resident requires an additional 30 days, please fill out the “Resident Evaluation Form” after initial 30 days.
Is the sober applicant working or looking for work?
*
Working
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Please allow 5-10 days for funds to arrive.