Online Application Form – Residential Rehabilitation

To apply for support within one of our projects, please complete the form below. Acceptance is subject to interview and risk/needs assessment. We are able to travel to meet you to do this. You can read our full eligibility criteria here

Application form

Your details

Your address

About you

Next of Kin

Conviction history

Your probation officer

Your stay

Your health

Referral agency

If self-referral or self-funding please state


If self-referral or self-funding please state


Other comments

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Get in touch

Kenward Road, Yalding, Maidstone, Kent ME18 6AH

01622 814187

For residenital services, or for weekend enquiries please call 01622 812603