Rising Above Peterborough - Request for Admission

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

The cost to attend the 6-month program is as follows:

monthly rent is $500/month,
a one-time damage deposit fee of $350,
and a one-time fee of $100 for program supplies.

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

Pension (CPP, OAP, Private)

Post-Traumatic Stress Disorder

Obsessive-Compulsive Disorder

Borderline Personality Disorder

* By checking this box, you understand the following fees are associated with our program. $500.00 Rent per month (adjusted if mid-month, to be paid upon entry) $350.00 Damage Deposit (to be paid upon entry) $100.00 Program Supplies Fee (one-time fee, to be paid upon entry) Participants buy their own groceries and make their own meals.

* By checking this box, you understand there is a mandatory requirement of 7-days clean from all drugs and alcohol. This includes all marijuana related products. Rising Above tests each individual before they are admitted. If you fail a drug or breathalyzer test, you will be denied entry into the program.

* By checking this box, I, the applicant, understand that if I fail my drug or breathalyzer test during admission, I will not be allowed into the program and accept all risks associated with the failed test. These risks may include difficulty finding transportation and accommodation, as well as potentially experiencing food insecurity.

* By checking this box, you, the applicant, are agreeing to the release of information contained in the Rising Above application you're submitting. The applicant understands that persons, professionals, agencies or institutions named in this application may be contacted for additional information or documentation. This information will be used to determine if Rising Above is a suitable service for you and will assist in program planning if you, the applicant, are accepted into the program. You, the applicant, understand that your personal information may be disclosed to an employee, agent or contractor of the Rising Above Program, to verify your eligibility for the program or to monitor, assess and evaluate the results of the benefits and support programs in the Rising Above Program. By checking this box you're agreeing to the release of your information and confirming you're 18 years of age or older. You, the applicant, understand that all incomplete applications will not be considered.

Rising Above Peterborough Peterborough

Request for Admission

FAMILY/SOCIAL NETWORK

MENTAL HEALTH STATUS AND COGNITIVE CONCERNS

LEGAL HISTORY

RESIDENTIAL FEES

CLEAN TIME REQUIREMENT

FAILED TEST RISK ACKNOWLEDGEMENT

CONSENT FOR RELEASE OF INFORMATION TO RISING ABOVE