If you are have recieved confirmation that you will be recieving financial assistance from a WAGEES provider it is your responsibility to go and complete intake within 24 hours of move in and have case manager provide confirmation via email to billing.hazelbrooksoberliving@gmail.com
that intake has been successfully completed and their intent to provide funding assistance
for what $ amount
additional requirements/terms of funding assistance (If their are things that are required to be completed in order to recieve assistance, this must be done within one week of move in.)
Please do not assume that funding is being taken care of, it is not responsibilty of Hazelbrook or of WAGEES provider to take care of this. it is your responsibilty to handle this and make sure Hazelbrook Sober Living billing dept is aware of process and recieves payment.
If this is not done in times explained above you will not be allowed to live at Hazelbrook
Any unpaid or late rent will be your responsibilty including late fees and other penalties incured to do financial non-compliance including discharge or unpaid balance being sent to collections agency.
Which WAGEES agency are you recieving assistance from? Text field
What amount are you receiving assistance for? Text field
Date of intake? Date
By signing below you acknowledge that you have fully read, understand and agree to this and all questions have been answered.
This form must be signed by house manager prior to move in
Client first name Client last name
Signature
Date
Text field