Scholarships

Midwest Recovery Centers is Excited to Offer a Formalized Scholarship Option!

Individuals with substance use disorder face more barriers to treatment than individuals with any other health issue. This is due to the stigmatization of addiction in the health community and its behavioral impact on those diagnosed with it. Midwest Recovery Centers aims to continue its efforts in reducing cultural, societal and financial barriers that accompany SUD by now offering a standing full-ride scholarship. This scholarship will allow marginalized and under-served groups in the community the opportunity to access top-tier, evidence-based, extended-care treatment at no cost. Scholarships will become available starting June 19th, 2022 and will be determined upon the basis of need, motivation to change, and bed availability.

Please note that incomplete applications will not be considered
All applications will be reviewed on a quarterly basis
Please do not call our Admissions line, we will contact you regarding a phone interview after reviewing eligible applications

Application

Verify Your Insurance Coverage

General Information
Who Is This For?*
Patient Full Name
First Last
Patient Date of Birth*
Patient Social Security #
Subscriber Full Name
Subscriber Date of Birth
Subscriber Social Security #
Email*
Home/Cell Phone Number*
How did you hear about us?*
Address
Address on file with your insurance carrier.
Street Address*
City*
State*
Zipcode*
Insurance Information
Insurance Carrier*
Insurance ID #
Provider Services Phone # (on back of card)*
Group ID #
Type of Plan
- PPO
- HMO
- EPO
- POS
- Unknown
Is this a COBRA Policy?
- Yes
- No
- Unknown
Photo Upload: FRONT of Insurance Card (optional)
Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.
Photo Upload: BACK of Insurance Card (optional)
Max. file size: 50 MB.
Additional Information
Have You Been to Treatment Before?
Brief Description of Your Problem
Comments
When and how is the best way to contact you?
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Substance	Length, amount and frequency of use	Method of use (IV, Oral, etc.)	Currently using?

Facility	Level of Care	Dates of Treatment	Successful Completion?

Scholarships

Midwest Recovery Centers is Excited to Offer a Formalized Scholarship Option!

Application

General Information

Address

Insurance Information

Additional Information

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