Our programs are intended for beneficiaries of the James Bay and Northern Quebec Agreement, as well as their spouses aged 18 or older, who need help with addiction or substance abuse and are committed to begin their healing journey. All our programs are admission free and include accommodation and meals.

Your three options to apply:

Fill

the online Application Form below

Download

the fillable Application Form (PDF)

Print

the Application Form (PDF) 

MEDICAL EVALUATION FORM

Fill it out

MESSAGE FOR REFERRAL WORKERS

Read the PDF

ONLINE APPLICATION FORM

Make sure your Internet connexion is stable and safe to complete this questionnaire.

  • If you have any questions while filling this form, do not hesitate to call us at 1-866-964-9994 and ask to talk to the Admission and Intake Worker.
  • We are available to support you and want the application process to be as smooth as possible. If you are applying from outside of Kuujjuaq, take note that travel arrangements can be made by your local social services for free. However, you can choose to pay for your transportation yourself
  • Please note that we treat every application with care and confidentiality.
  • Our clinical team will communicate with all applicants by email primarily.
  • All applicants are invited to fill out this form themselves or with the support of a referral worker such as a probation officer, lawyer, or social worker.
  • We ask that you provide the answers either in English or in Inuktitut.

REFERRAL WORKER INFORMATION / ᐃᓱᐊᕐᓯᕕᓕᐊᕐᑎᓯᔪᑦ ᐱᓇᓱᑦᑎᖓᑕ ᖃᐅᔨᒪᔭᐅᒋᐊᓕᖁᑎᖏᑦ / Information sur le travailleur de référence

If you got help from a referral worker to complete this form, please answer the questions below (light grey box). If not, go directly to the General Information section. ᐃᓱᐊᕐᓯᕕᓕᐊᕋᓱᐊᑐᐊᕈᕕᑦ ᐃᑲᔪᕐᑕᐅᓗᑎᑦ ᐃᓱᐊᕐᓯᕕᓕᐊᖁᔨᔪᑦ ᐱᓇᓱᑦᑎᖓᓄᑦ, ᐅᑯᐊ ᑭᐅᒪᒃᑭᑦ ᐊᐱᕐᓲᑏᑦ ᐊᑖᓃᑦᑐᑦ. Si vous avez obtenu de l'aide d'un travailleur de référence pour remplir ce formulaire, veuillez répondre aux questions ci-dessous.

General information / ᐃᓘᓐᓈᒍᑦ ᖃᐅᔨᒪᔭᐅᒋᐊᓖᑦ / Renseignements généraux


Man / ᐊᖑᑎ / HommeWoman / ᐊᕐᓇᖅ / Femme



English / ᖃᓪᓗᓈᑎᑐᑦInuktitut / ᐃᓄᑦᑎᑐᑦ


Basic / ᐱᒍᓐᓇᓯᐊᖕᖏᑐᖅ / BaseIntermediate / ᐱᒍᓐᓇᒐᓚᑦᑐᖅ / IntermédiaireGood / ᐱᒍᓐᓇᑐᖅ / BonneExcellent / ᐱᒍᓐᓇᑐᓪᓚᕆᒃ / Excellente




Single / ᐃᓄᑐᐊᖅ / CélibataireCommon Law / ᐃᑦᑐᓱᒃ/ᓂᖏᐅᓱᒃ / Conjoint de faitMarried / ᑲᑎᑎᑕᐅᒪᔪᖅ / MariéDivorced / ᑲᑎᑎᑕᐅᒪᒍᓐᓀᑐᖅ / Divorcé




No / ᐊᐅᑲ / NonYes / ᐋ / Oui



No / ᐊᐅᑲ / NonYes / ᐋ / Oui



No / ᐊᐅᑲ / NonYes / ᐋ / Oui



Elementary School (1 to 6) / ᐳᒃᑭᓂᕐᓴᖅ (1-ᒥᑦ 6-ᒧᑦ) / Primaire (1 à 6)High School (1) / ᐳᕐᑐᓂᕐᓴᖅ (1) / Secondaire (1) >(2)(3)(4)(5)Continuing Studies / ᑲᔪᓯᓂᖅ ᐃᓕᓐᓂᐊᓂᕐᒥᒃ / Études permanentesCertification / ᐃᓕᑕᕆᔭᐅᒍᑎ / AttestationCollege / ᐳᕐᑐᓂᕐᓴᒋᐊᓪᓚᒃ / CÉGEPUniversity / ᐃᓕᓐᓂᐊᕕᕐᔪᐊᖅ / Université



No / ᐊᐅᑲ / NonYes / ᐋ / Oui


Alcoholic Anonymous / ᐃᒥᐊᓗᒻᒥᒃ ᓄᕐᖃᖃᔦᕐᓯᒪᔪᑦ ᑲᑎᖕᖓᓂᖓ / Alcooliques anonymesCommunity Workers / ᓄᓇᓕᓐᓂ ᐱᓇᓱᑦᑏᑦ / Travailleurs communautairesSocial Services / ᐃᓄᓕᕆᔨᒃᑯᑦ / Services sociauxNatural Helpers / ᐃᑲᔪᕐᑎᑐᐃᓐᓀ / Aidants naturelsᑦOther / ᐊᓯᖏᑦ / Autres



No / ᐊᐅᑲ / NonYes / ᐋ / Oui

DEPENDENCY BACKGROUND / ᐅᐃᕆᒪᓃᑦ / HISTORIQUE DE DÉPENDANCE




Yes / ᐊᐅᑲ / OuiNo / ᐋ / NonI don't have dependency issues / ᐅᐃᕆᒪᓂᕐᒥᒃ ᐱᓀᓗᑕᖃᑦᔭᖏᓪᓚᖓ

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Yes / ᐊᐅᑲ / OuiNo / ᐋ / Non









Yes / ᐊᐅᑲ / OuiNo / ᐋ / Non






Yes / ᐊᐅᑲ / OuiNo / ᐋ / Non


No (it's my decision) / ᐊᐅᑲ (ᓇᒻᒥᓂᖅ ᑐᑭᑖᕋ) / Non (c'est ma décision)Yes (for someone) / ᐋ (ᐊᓯᒐᓄᑦ) / Oui (pour quelqu'un)


Quitting alcohol or drugs / ᓄᕐᖃᓂᖅ ᐃᒥᐊᓗᒻᒥᒃ ᐊᒻᒪᓗ/ᐅᕝᕙᓘᓐᓃᑦ ᐋᖓᔮᓐᓇᑐᓂᒃ / Arrêter l'alcool, les droguesReducing my consumption / ᐱᓪᓗᐊᖃᔦᕐᓂᒥᒃ / Réduire ma consommation

SUICIDAL RISK ASSESSMENT / ᐃᒻᒥᓂᐊᑐᐃᓐᓇᕆᐊᖃᕐᓂᖓᓂᒃ ᖃᐅᔨᓴᕐᓂᖅ / ÉVALUATION DU RISQUE DE SUICIDE


Yes / ᐊᐅᑲ / OuiNo / ᐋ / Non

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Yes / ᐊᐅᑲ / OuiNo / ᐋ / Non

No / ᐊᐅᑲ / NonYes / ᐋ / Oui


If you are currently experiencing suicidal thoughts, we strongly recommend that you ask for help. Please contact one of the following resources as soon as possible: emergency services, your local clinic, your referral worker, a social worker in your community, a life helpline, etc. / ᐃᒻᒥᓂᐊᕐᓂᒥᒃ ᐃᓱᒪᖃᑦᑕᑐᐊᕈᕕᑦ ᒫᓐᓇ, ᐃᑲᔪᕐᑕᐅᒍᒪᖁᔨᓪᓚᕆᒃᑯᒍᑦ. ᐅᖄᓚᒋᑦ ᐅᑯᐊ ᐊᑐᐃᓐᓇᐅᔪᑦ ᓇᓪᓕᐊᓄᑦ ᒫᓐᓇᓴᐅᑎᒋᒃ: ᐅᐃᒪᓇᕐᑐᒥᒃ ᐱᒍᑦᔨᔩᑦ, ᓄᓇᓕᑦᓯᓂ ᐋᓐᓂᐊᕕᒃ, ᐃᓱᐊᕐᓯᕕᓕᐊᖁᔨᔪᑦ ᐱᓇᓱᑦᑎᖓ, ᐃᓄᓕᕆᔨ ᓄᓇᓕᑦᓯᓂ, ᐊᑭᖃᖕᖏᑐᖅ ᐃᑲᔪᕐᑕᐅᕕᒃ ᐅᖄᓚᐅᑎᒃᑯᑦ, ᐊᓯᖏᓪᓗ. / Si vous avez actuellement des idées suicidaires, nous vous recommandons fortement d'aller chercher de l'aide immédiatement. Veuillez contacter dès que possible l'une des ressources suivantes : les services d'urgence, la clinique de votre communauté, votre travailleur de référence, un travailleur social, une ligne d'assistance téléphonique, etc.

APPLICANT RELEASE / ᐃᓱᐊᕐᓯᕕᓕᐊᕋᓱᐊᕈᑎᒥᒃ ᑕᑕᕐᓭᔫᑉ ᐊᖏᕈᑎᖓ / RENONCIATION DU DEMANDEUR


Our services are suspended until further notice - Read more
Nos services sont suspendus jusqu’à nouvel ordre - Tous les détails
ᐃᓱᐊᕐᓯᕕᒃ ᓄᕐᖃᑎᑦᓯᑫᓐᓇᑐᖅ ᐱᒍᑦᔨᓂᕐᒥᓂᒃ ᖃᐅᔨᑎᑦᓯᒍᑎᐅᒋᐊᓪᓚᖏᓐᓂᖓᓂ COVID-19 ᐱᑦᔪᑎᒋᑦᓱᒍ - ᐊᓪᓚᓂᐊᕆᐊᓪᓚᕆ
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