Sober Living Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastGender-Select--Select-MaleFemaleAddressDate of Birth *Phone NumberEmailMarital Status-Select--Select-SingleMarriedDivorcedSeperatedEngagedWidowedCurrent Living Situation -Select--Select-Personal ResidenceLive with FamilyTreatmentIncarceratedHomelessEmergency Contact InfoAre you required to register as a sex offender? *-Select--Select-YesNoDo you have any active warrants?selectselectYesNoList Criminal Historyif none please put N/ADrug of Choice *MethFentanylAlcoholHeroinMarijuanaSobriety DateAre 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 NameWhat 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? *-Select--Select-YesNoBy selecting No, your application may be delayed if you have a PO.Submit Sober Living Application (1)Download Serenity Bridge Release of InformationDownload
