Sober Living Application

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

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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