Home About Us Apply Contact Us Guest Application Second Chance MA welcomes guest applicants on their recovery journey. Please complete all sections below. First Name Last Name Date of Birth Are you in recovery? Yes No Date of Last Use Gender Identity Select Option Male Female Nonbinary Email Address Cell Phone # Requested Move-In Date Requested Location How did you hear about us? Referred By Are you in a program? Yes No Caseworker Info Are you a felon? Yes No Are you on probation / parole? Yes No How will you pay rent? Work Grant Assistance Applicant Signature Date By signing above, I confirm that I am actively pursuing recovery from substance use disorder. I authorize Second Chance MA and its staff to conduct a background review and authorize any individual or agency to provide staff with verbal or written information about me. I understand that my application is subject to approval. Submit Application
