Support Services Application

We're here to help

To qualify for support services, applicants must meet the following criteria:

• Must be a current resident within the city limits of Dickson, Tennessee.

• Must be actively enrolled in a reputable substance abuse treatment program.

• The treatment facility must be licensed by the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS).

• Must show a legitimate and current need for services.

Get the support you need

We're here to help you on your journey.

Full Name *

Date of Birth *

Phone number *

Email address *

Home Address (must be within Dickson, TN city limits) *

Treatment Facility Name *

Facility Address *

Facility Phone Number *

Treatment Start Date *

Expected Completion Date *

Licensed by Tennessee Dept. of Mental Health and Substance Abuse Services? *

File Upload: Letter of Enrollment or Proof of Active Participation in Treatment Facility *

Which support service(s) are you requesting? *

Please select at least one option.

Food Assistance

Clothing Assistance

Hygiene Items

Job Placement

Career Counseling

Higher Education Assistance

Describe Your Specific Needs and Circumstances *

Are you currently employed? *

If yes, Employer Name and Position

Monthly Income *

Other Sources of Income

Have you previously received support services from Freeman Recovery Project? *

What challenges are you currently facing in your recovery journey? *

Please select at least one option.

I allow this website to store my application details so they can respond to me. *

Signature *

Date Submitted *

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