Application for Admission


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Application Instructions

P.O. Box 10878• Prescott, AZ 86304• (888) 391.9772 Upon completion of application, please fax to (928) 441.2444

We appreciate, value, and welcome your interest in The PAC Program as well as beginning the recovery

Please complete the following application as thoroughly and honestly as possible. The information presented will help us in determining the appropriateness of our program for the applicant. Should the applicant be accepted and admitted, the accuracy of the information in each section will assist us in effectively understanding and helping the applicant with their recovery process.
Admission Requirements and Criteria
The PAC Program is not a medical facility. In the event that the applicant is not medically appropriate for admission, The PAC Program will require the applicant to enroll in a medical detoxification program. We will help facilitate an appropriate referral. The PAC Program does not accept any responsibility for the transportation, monitoring, or making arrangements for the applicants medical care but we are here to help you with that process.
The PAC Program is a voluntary program that challenges young men to participate in their recovery process. We are committed to this process and in creating a safe environment for the applicant to flourish in their recovery.
Additionally, it is understood that if the applicant is unwilling to participate, refuses to engage in the curriculum, or recalcitrant at any time during their tenure, The PAC Program reserves the right to immediately discharge the participant. In that situation, we assume no responsibility for the transportation, monitoring, or making arrangements for transfer to another facility.