New Start In-patient Treatment Funding Application

New Start Foundation envisions a world where all Canadians can receive effective, equitable and timely mental
health and addiction treatment. Eligibility will be based on both clinical and financial need. Applicants must be
Canadian and over the age of 18.

Application Process

Each applicant must:

1. Complete the financial application form
2. Complete the clinical assessment
3. Provide proof that all resources have been exhausted
4. Provide information regarding income, income tax, assets and bank information

Financial Application Form
Applicant Information (if different than payer/caregiver information below)
Payer Information
Payer Employment Information
Health Insurance Information
Co-Payer Information
Co-Payer Employment Information
Co-Payer Health Insurance Information
Income Statement
Combined Payer and Co-Payer Income Description