Rob Mathews Memorial Foundtion
   

Petition for Scholarship Request

The purpose of this petition is to request financial aid for a unique/effective form of treatment focused on repairing the biochemical imbalances underlying alcohol and drug abuse. Consideration for financial aid is often, but not solely, based on an individual’s past history and financial needs, so please be thorough in your answers. You may mail your answers to:

Rob Mathews Memorial Foundation
3255 Hennepin Ave So
Minneapolis, MN 55408

Or you may respond by e-mail.
Our e-mail address is

Feel free to attach additional information. All financial aid requests are reviewed by Rob Mathews Memorial Foundation board members, and kept confidential.

Name                                                               Date
Address
City                                                                 State                                        Zip
Day Phone                                                      Evening Phone
Amount Request
Purpose of Request

  1. How did you hear about Health Recovery Center?
  2. Describe in detail, why you need support from the RM Foundation?
  3. Please describe a brief history of your alcohol/drug use and treatment history.
  4. Are you currently on a SSRI drug or any other psychiatric medication?
  5. What is your ongoing support system for sobriety, including financial for continued nutrient use?