Independence Again Forms

Rx Form

Rx Pad

Click the Picture to complete the Medication form any time your Rx changes, or if you take an Over-the-counter medication for longer than 3 days.

Rent Assistant Request Form

Piggy Bank

Assistant is limited and approval is not guaranteed. If you feel at any time you will be unable to pay your rent on-time please complete this form in advance to avoid discharge or late fees. 

Online Application

Please call 931-510-9775 if you would like to complete the application on paper form. 

Release of Information

Click the picture to complete the Independence Again Release of Information Form. *Staff may require written signature.

Work Order Request

Something broken or needing to be done? Click the Image above to submit a Work Order for it.

Credit Card Authorization Form

Behind on your rent or want to pay with your Credit Card? Click the Image above to fill out the Credit Card Authorization Form.

Independence Again Specific information

Waiting List

We at Independence Again know that there is a shortage of Safe Havens for those seeking Sober Living, we are working on this regularly and hope to have additional options in the near future. We will also work with you to find sober living in other locations where possible.

 

Please see below where you are on the list  we will call when a program opportunity arises:

0-9951006 - CKS

 

*If you believe you should be on the list and are not please contact Lynda at 931-510-9775.