Begin Your Healing Journey by telling us about yourself!

Welcome to IGNITE! We are glad you decided to take the first step on your healing journey.


FIll out the application to the best of your ability and a member of the IGNITE team will reach out to set up the initial consultation to learn more about you as well as tell you more about the IGNITE program!

Phone

Housing & Income

Do you own or rent*
How many people are in your household?*
Are you currently a mom of a child less than 5 yo

for Ignite state grant qualification

Are you a foster or adoptive family?

for Ignite state grant qualification

Employment Status

Social & Emotional and Addiction History

check all that apply


Have you received previous MH counseling?*

MH = Mental Health

If yes, tell us why it was helpful

If no, please explain why

check all that apply


Are you Currently Sober?*

check all that apply


Check all that apply


Are you comfortable working with:*

Goals and Barriers to Achieving Your Goals

Mental Health and Wellbeing -

Physical Health and Wellbeing -

Spiritual Health and Wellbeing -

How many hours can you commit to the IT program?*

What areas of community involvement interest you and what talents could you lend to this service?



That is important for Ignite Transform to know or is significant in your journey to healing.

Thank you for filling out the IGNITE Transform Application

You have taken a very important first step and we look forward to walking alongside you on this journey!

The IGNITE Team