Programs
Thrift Stores
- Stores
- Estate Sales
Mission
- About Us
- Our History
General Info
Get Involved
Donate

Apply to a Recovery Program

Fill out the form below. We review applications at the end of the week and will respond within 10 days.

"*" indicates required fields

Name*

First Middle Last

Email*

Phone*

Address

Street Address Address Line 2 City State ZIP Code

Select program*

Additional Information

Date*

MM slash DD slash YYYY

Age*

Sex*

Untitled

Highest Level of Education*

Do you possess a valid driver's license?*

Yes

No

Do you understand that you will not be permitted to work outside of Restoration Ministries for the first year of your stay?*

Yes

No

What is your drug(s) of choice?*

Last Time Used?*

How Often Used?*

How long have you suffered from addiction?*

Length of Stay*

Are you currently in a detox program or other treatment?*

Yes

No

Please select the name of the program*

Date of Detox Program Release*

MM slash DD slash YYYY

Name of current program*

Please provide the name of your counselor*

Best phone number to call while at current program*

Are you under parole?*

Yes

No

Are there any special requirements of your parole, such as anger management, parenting or other types of classes?*

Yes

No

Are you currently incarcerated?*

Yes

No

How soon would you like to join our program?*

Are you willing to submit to a background check as part of the acceptance program?*

Yes

No

Are there other programs or services that you need?*

Yes

No

What other programs or services do you need?*

Describe your spiritual journey and religious beliefs*

Medical Information

Describe any medical conditions we should know about when we assign daily routines?

Please list any medications and dosage amounts that you are currently taking and the reason for taking them.

Are you currently under the care of a counselor, psychologist or psychiatrist?*

Yes

No

Have you been vaccinated for Covid?*

Yes

No

Please know that proof of vaccination is required to participate in our program

Are you willing to be vaccinated as part of your acceptance into this program?*

Yes

No

Housing Information

What housing options are available to you if you are not accepted into this program?

What housing options will be available to you if you successfully complete this program?

Describe your family’s participation in your recovery (parents, siblings, children).

Have a question?

Phone Number

708.333.3370

Address

253 E 159th Street, Harvey IL 60426

Thrift Store Pick-Up

Schedule a Thrift Store Donation Pick up: 708-876-8413

© 2026 Restoration Ministries