Apply for Program//

Name *
Phone *
Are you currently pregnant? *
Do you have any other children? *
Have you had any history with drugs (including marijuana) or alcohol? *
If yes, have you been to a treatment program? *
We are a clean facility; would you commit to not using drugs (including marijuana) or alcohol while you are at Special Delivery? *
Are you willing to attend weekly classes, meetings and counseling sessions? *
Our program is located in Woodinville, Wa. Woodinville has limited public transportation access. Will this be a problem for you? *
Special Delivery is a faith based program, would you be willing to participate in bible studies and attend church? *
Are you willing to live in community with other residents and participate in daily chores? *