Apply Now

Eligibility Requirements

1 Willing to live drug and alcohol-free (including THC and CBD).

2 The cost is $150 per week.

3 One-time intake fee of $200.

4 Must test drug-free upon move-in.

5 Subject to random drug testing.

6 Rooms are shared.

7 Prescribed Rx allowed, but must be kept in personal safe provided by the Keepsake Abode Foundation.

Donate Keepsake Abode Foundation

Submit Very carefully, and Our Team Member will get back to you soon.

Please enable JavaScript in your browser to complete this form.

Name

First

Last

Phone

Your current address

If you don't have a physical address, you can use a mailing address, or the address of your closest living relative. If this is NOT your address, please indicate whose address this belongs to, and their relationship to you

Preferred communication Method

Marital Status

Select Your Gender

Current gender identity

Date of Birth

What is your highest completed level of education

Are you seeking to continue your education?

If so, could you tell us more? If you're currently enrolled, please include which school and classes you're taking.

Do you have any allergies? If so, please list them here.

Are you taking any prescribed medications?

If so, please list them here. Do not leave this question blank. Please write "none" or "N/A" if you have no current prescriptions to acknowledge that you've answered this question.

Have you completed any type of sobriety program?

Please list any support groups, church, community, or other meetings that you attend on a regular basis.

This could attending AA, NA, or SAA meetings. Do not leave this question blank. Please write "none" or "N/A" if you're not attending any meetings as a means to acknowledge that you've answered this question

How long have you been sober?

Do you smoke or chew tobacco?

Smoking or chewing tobacco is not prohibited at any of our homes; however, you must do so in designated areas.

What should we know about you to assist you to assist you in your recovery?

Do you have a job?

Do you have a vehicle?

Do you have a drivers license?

Which agencies are you affiliated with?

Please list all, including names of your case worker, and / or point of contact for each agency. Do not leave this question blank. Please write "none" or "N/A" if you're not affiliated with any local agencies as a means to acknowledge that you've answered this question.

How are you planning to pay the required program intake fee?

Are you currently on probation?

Pending legal charges (if any)

Do not leave this question blank. Please write "none" or "N/A" if you have no current pending legal charges as a means to acknowledge that you've answered this question.

Incarceration / arrest history

Any charges pending? Please include charge[s], county, status, and DOC number. Do not leave this question blank. Please write "none" or "N/A" if you have no arrest record as a means to acknowledge that you've answered this question.

Are you willing to live in an alcohol and drug free environment, including THC and CBD? (copy)

Emergency Contact #1

You must include the following: Their first and last name, phone number, email, address (including city, state, and zip), and their relationship to you.

Emergency Contact #2

You must include the following: their first and last name, phone number, email, address (including city, state, and zip), and their relationship to you.

Any additional comments?

Apply Now with PDF

APPLY NOW

SUBSCRIBE NOW

Subscribe now to stay updated with latest news and trends

Keepsake Abode Foundation

OUR mission is to provide a safe haven for individuals facing various challenges in life. We are dedicated to offering temporary shared community and transitional or permanent residential housing accommodations for those who need it the most. Our unwavering commitment is to uplift and empower individuals who are.

EIN #: 93-1400537.

Keepsake Abode Foundation is a 501(c)(3) organization.

ContactRendit Bitrow

622 Central Avenue, Suite 1000, Johnstown, PA 15902

info@keepsakeabodefoundation.org

814.458.8668

DONATE NOW