Follow the steps to successfully complete your application online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the application date. Fill in the month, day, and year to specify when you are submitting your application.
3. Provide your full name. Ensure that you include your last name, first name, and middle name(s) if applicable.
4. Next, enter your date of birth in the specified format. Use 'MMM' for the month, followed by the day and year.
5. Specify your gender by selecting the appropriate option. Options include female, transgendered male to female, male, and transgendered female to male.
6. Provide your ethnicity, selecting from the options provided or noting any other relevant background.
7. Enter your Social Insurance Number (SIN) and Personal Health Number (PHN) if applicable.
8. Complete the section on living situation from the previous night, choosing the most applicable option from the list of options provided.
9. Indicate the length of stay at your living situation last night and provide any relevant details regarding your extent of homelessness if applicable.
10. In the section detailing reasons for your current situation, select all that apply to you.
11. Provide information regarding your sources of income by selecting the relevant categories.
12. Fill out your education history, specifying your highest level of schooling completed.
13. If applicable, indicate your legal status and provide any background that may be relevant to your application.
14. In the general health assessment section, rate your overall health and provide any details about chemical or process addictions.
15. Complete the health concerns sections by listing any medical and mental health issues you are currently facing.
16. Provide contact information for your current or recent health care providers.
17. Read and acknowledge the disclosure section by providing your name and contact information.
18. Detail your treatment history and goals, including any previous addiction treatments and your objectives for this program.
19. Finally, affirm that all provided information is accurate, sign, and date the application.
20. Once you have completed filling out the form, save your changes, download a copy for your records, and prepare to email your completed application to the designated address or fax it to the provided number.

Take the first step towards recovery by completing your application online today.