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Program Placement Application

This application is the first step in seeking program placement assistance through Pilgrims Path.

 

We understand that addiction is complex, and not every program is the right fit for every person. Pilgrims Path exists to help individuals and families navigate the often overwhelming recovery landscape by identifying treatment and recovery programs best suited to each individual’s specific needs, history, and circumstances.

 

By completing this application, you are asking for guidance in finding appropriate placement options. The information you provide helps us understand your situation more clearly so we can offer informed recommendations, advocate on your behalf when appropriate, and help remove unnecessary barriers to treatment—including legal or court-related concerns.

 

Submitting an application does not guarantee placement in a specific program, but it does allow our team to begin walking with you through the process. Our goal is to provide honest direction, realistic expectations, and Christ-centered support every step of the way.

 

All information shared will be treated with care and discretion.

 

If you are ready to take the next step toward recovery—or are seeking help on behalf of someone you love—we encourage you to complete the application below. You do not have to navigate this process alone.

Pilgrim's Next Step

Applicant Information

Date of Birth
Month
Day
Year

Emergency Contact

Addiction & Recovery Background

Spiritual Background

Health & Legal Information

Program Expectations

Are you willing to follow all guidelines of a placement program and rehab facility?
Yes
No

Confidentiality Agreement

Pilgrims Path is committed to safeguarding your personal information. All information provided in this application, along with any assessments or conversations with staff, will remain confidential. Details may be shared only with approved rehabilitation centers as needed and only with your consent.

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Date
Month
Day
Year

We are a nonprofit organization exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3)
EIN: 41-2951868

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