Sober Living Application

Sober Living Application

Are you looking for a safe environment to remain sober from all substances (Not including prescribed medications)
Name
Address
MM slash DD slash YYYY
Are you currently on Probation or Parole?
If Yes, Please Provide the Probation Officers Name and Phone number
Please list all charges
Do you have an active protection order against somebody?
If accepted, NWSL will need a copy

Recovery Information

Are you in Recovery From
Do you take prescribed medication?
Please list and give reason being taken
Have you been in substance abuse treatment within the last 3 years?
Are you currently in a self-help recovery or other recovery program
Do you have a Sponsor
Are you now, or will you be on a medication assisted treatment (i.e. Methadone, Suboxone)

Employment

Employer
Address
please explain

List your two most recent residences

Address
MM slash DD slash YYYY
MM slash DD slash YYYY
Address
MM slash DD slash YYYY
MM slash DD slash YYYY

Emergency Contact Information

In case of relapse, Contacts will be notified