Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Full Name *Date of Birth *Phone Number *Email Address *Background & Recovery History *Brief overview of your background, including your recovery journey. Applicants must not have arson or sexual offense history.Reason for Applying *Explain why you are seeking sober living and how it aligns with your recovery goals.Commitment to Sobriety *Highlight your commitment to maintaining sobriety and any steps you have taken to support your recovery.Support System *Mention any support systems you have in place, such as family, friends, peer coaches, case management, or support groups.Goals *Outline your short-term and long-term goals while in sober living.ReferencesProvide references who can vouch for your commitment to sobriety and your character (include contact info).Financial Commitment Acknowledgement *I understand the program fee is $850 per month.I understand there is a $150 quarterly supply fee.I understand program fees are non-refundable if program rules are violated.Program Rules & Agreement *I understand violations may result in immediate removal.I understand I may have limited time to gather personal property if asked to vacate.I understand I am responsible for transportation if asked to leave.I agree to follow all program rules and expectations.Electronic Signature *Typing your full name acts as your electronic signature.EmailSubmit Application
