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RAPID WELLNESS 4-U — Free Recovery Assessment
RAPID WELLNESS 4-U — Stability Bundle Intake
We help individuals transitioning from treatment and incarceration find stability. Complete this form to begin your path to housing and career development. Your journey to stability starts here.
Contact Info
Full Name
*
Phone Number
*
Email Address
*
Section 1: Basic Identity & Intent
Desired Move-in Date
*
Section 2: The "Connection" Phase (Government Phone)
Do you have a valid Arizona State ID?
*
A
Yes
B
No
Do you currently receive AHCCCS or Food Stamps (SNAP)?
*
A
Yes
B
No
Have you had a government-funded phone in the last 6 months?
*
A
Yes
B
No
Section 3: The "Stability" Phase (Housing)
Are you looking for Professional/Career-Based housing or Stabilization housing?
*
To maintain residency in our partner homes, you must commit to 20 hours of volunteer work per week for the first 30 days. Do you agree to this term?
*
A
Yes
B
No
Housing Preferences
*
Men's
Women's
Couples
Section 4: The "Purpose" Phase (Career/Certification)
Are you currently certified as a BHT (Behavioral Health Technician) or Peer Support Specialist?
*
A
Yes
B
No
Please upload a photo/PDF of your certification.
Are you interested in House Manager or Lead BHT roles?
*
A
Yes
B
No
If you are not certified, would you be interested in receiving information on BHT/Peer Support certification classes?
*
A
Yes
B
No
Section 5: Final Vetting & Next Steps
Briefly describe your goals for the next 90 days.
*
I understand that a 3-minute Zoom interview and a vetting process are required before placement.
*
I agree
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