General Applicant Information
Substance Use and Mental Health Treatment History
Please list a history of drug/alcohol treatment including residential, hospital, or outpatient. DO NOT include detox or DUI.
Please list all substances used including alcohol, tobacco, marijuana, illegal drugs and prescription drugs. Please list in the order of use starting with the most recent.
Written Response Section
For each of the following questions, please give complete answers in paragraph form. Answers should range between 3-5 sentences each.
Reminder to all applicants, please note:
Please acknowledge the following Terms & Conditions: