Sober Living Application

Discover recovery, hope, and healing at Serenity Bridge Sober Living Homes

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Name

First

Last

Gender

Address

Date of Birth

Phone Number

Marital Status

Current Living Situation

Emergency Contact Info

Are you required to register as a sex offender?

Do you have any active warrants?

List Criminal History

if none please put N/A

Sobriety Date

Are you in a 12 Step Program?

If yes please specify.

If you're currently in treatment, jail or halfway house, when is your release date?

Treatment Provider or Halfway House Info:

Please input Name, Address, Phone number, Case Workers Name

What are some short term goals you have?

Probation officer's Name and Number:

Do you give us permission to contact the treatment center, halfway house or probation officer?

By selecting No, your application may be delayed if you have a PO.

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