Make a General Donation

Speak with an AdvocateFill out the confidential form to request a call from an Advocate

Application for Advocate for Hope

Name *

Email *

Phone Number

To which Advocate for Hope would you like to speak?

List the substance use and/or co-occurring mental health disorders for which you are seeking assistance *

How can ARCHway support you? *

Are you currently being treated somewhere? If yes, where? (Organization Name, City and State)

About You

Would you mind answering a few questions to help us better understand your needs?

This information will not be used for discriminatory purposes. It will be used to ensure that ARCHway is servicing as many and as wide a variety of people as possible.

Only pertinent ARCHway staff members will have access to this information. Your responses will be kept private and secure.

What is your date of birth?

What is your gender identity?

What is your zip code?

Do you identify as a person with a disability or are you a person with accessibility needs?

Yes (describe)Yes (describe)

Prefer not to say

Which racial/ethnic groups best describe you? (select all that apply)

American Indian or Alaska Native

Asian

Black or African American

Caucasian (light-skinned; of European origin)

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

Prefer not to say

What is the highest level of education you have completed? Select one.

Some high school, no diploma

High school diploma or GED

Some college, no degree

Associate (2 year) degree

Bachelor’s (4 year) degree

Master’s degree

Doctorate degree

Prefer not to say

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