Justice - APPLICATION FORMS - Jackson Lake Land-based Healing Program

The referral process is a two-step process:

Step1:  Screening Application Form – The Screening and Application Form will be completed by the referring agent and participant. Please submit to JLWT by fax or email using the contact information on the front cover on the form.

The completed form will be reviewed and a decision made and communicated to the referral agent within five working days of receiving the form. If the decision is “no” based on the completed Form, a reason will be given.


Step 2: Screening Application Form Medical assessment and Guidelines – If the admission criteria are met based on the review of the completed Screening Application Form (Step 1), the referring agent will be notified. Then Step 2 of the process - Screening and Application Form (Step 2) can be completed and submitted to JLWT as soon as possible.


A “yes” on the Screening Form (Step 1) does not mean definite acceptance to the program but all efforts will be made to offer a place in the program if possible.


For more information about the Jackson Lake Wellness Program and related healing programs, please visit the Jackson Lake Wellness Team webpage.