Residental Treatment Program
Transitional Living Program
Scattered Site Program

To make referrals to these programs you may complete the required documents listed below and fax them to Anchor Families at (765) 529-2495.

-OR-

You may contact the Anchor Families program director, Tracy Chambers, at (765) 529-2444.

• Admission Application*
• Placement Agreement*
• Placement History
• Communicable Disease Affidavit
• Physical Control Statement
• Consent of Release of Confidential Information*
• Allowed Contact List
• Signed Consent for Emergency Medical and/or Surgical Care*
• Financial Responsibility and Responsibility for Detention*
• Medical History*
• Permission to Photograph
• Consent for Leaves Away from Campus
• Religious Reference Documentation

Documents with an asterisk (*) are required. These documents are Adobe Acrobat files and require Adobe Reader. You may go to the Adobe website to download Adobe Reader.