Here, you can fill out and submit your application, right from your computer.  The application process is not a short one.  The application itself is 12 pages.  Click on each "drop-down" menu to view all areas of the application to be sure that you allocate enough time to finish.  You cannot save changes and come back later, so it is advised to complete all of the questions in one sitting.  Some of the fields are required.  This means that you cannot submit an incomplete application.  Thank you for your interest in the program.

I. General Information
II. Personal Information
III. Personality Information and Mental Health History
IV. Parental Family History
V. Legal Status
VI. Employment
VII. Physical Heath History
VIII. Family History
IX. Drug History
X. Spiritual
Email Address:

***By submitting this application, I a am signifying that:
- I have read the RestorationCity Requirements booklet in its entirety.
- All Information I have provided is accurate and truthful.

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