Restoration House Application

Restoration House Application
Instructions: Please ensure you have a sufficient amount of time to complete this application. Applications submitted incomplete will be rejected. Write None of N/A in blanks that don't apply to you. This form will take a minimum of 45 minutes to complete.
SECTION 1: SUITABILITY

Restoration House is a rigorous, highly accountable Residential Recovery Support Services Program. It is not for everyone. Restoration House is literally an honest-to-God Program for men and women so sick & tired of being sick & tired that they will do whatever it takes to find a better way to live. If your way worked, you wouldn’t need what we offer. All who humble themselves and work this Program our way discover their past redeemed, their present transformed, and their future restored. Our way involves honesty & accountability in all things and relational abstinence for the duration. To determine whether Restoration House is right for you, check ONLY the boxes of those policies you KNOW you can live with for at least six months. Mismatches between people & programs never end well.
Can you be a part of an Unapologetically Christ-Centered Twelve Step Recovery?
Initial Here
Daily MAP Meetings. Just showing up is not enough. MAP means Mandatory Attendance &Participation.
Initial Here
Daily Reading & Writing Assignments. You must be able to read, write, and communicate clearly. Daily written A.A. or N.A. StepWork and sponsor-verified completion of Steps 1-9 required to graduate.
Initial Here
Minimum Six-Month Commitment: There are no shortcuts; it could take longer.
Initial Here
Relational Boundaries: Except for official business, communication or contact (including calling or texting) with members of the opposite sex (or same sex if so oriented) is prohibited. Possessing or accessing pornography is also prohibited. If you are unwilling to fully embrace these standards, stop here. This Program will not work for you.
Initial Here
EVERYONE ENTERS AT LEVEL 1. Level 1 Boundaries include:
Destination Restrictions: Mandatory Meetings, job search, approved service work & official business only.
Initial Here
Contact Restrictions: Beyond relational boundaries, all LEVEL I contact & communication is strictly limited to official business, employers, sponsors, Program leaders &same-gender Participants only. Waiver requests for limited LEVEL 1 contact with parents and minor children are reviewed on an individual basis.
Initial Here
Self-Reporting Honor Code: All Participants are required to self-report Program policy violations and to report all others who fail to self-report, including Staff.In contrast to the cowardly, self-serving practice of snitching to deflect scrutiny & save ourselves, the Restoration House Honor Code saves lives by saving us from ourselves. Honor coding by everyone makes the Program safe for everyone. It is not optional; if you are unwilling to Honor Code, stop here.
Initial Here
Documented Full-Time Job Search. Until you have a job, your full-time job is finding a real job. No working Sundays before 1:00 p.m. or Monday through Friday after 6 p.m. without an approved hardship waiver.
Initial Here
Program Fees: Due in advance. $150/week or $480/month. A temporary balance of past-due fees is permitted during Job Search only. All past-due fees are subject to the 80% Rule.
Initial Here
80% Rule: Participants with past-due Program Fees must pay 80% of all funds acquired from any source until current and provide official, accurate documentation of all earnings. Fees must be current to level up.
Initial Here
Grievance Process: A non-retaliatory Grievance Process is available to all for any perceived mistreatment.
Initial Here
Before moving on to the next page of the application, please read the following statement carefully and sign below:

"I swear or affirm I have been honest in my responses to all information requested herein. I give my consent to CrossBRIDGE to confirm all information provided."
E-Signature *

Clear

ALL APPLICANTS MUST COMPLETE:
I completed this application

without assistance with the assistance of
Name & Relationship of the person who assisted you:
“I swear or affirm that my responses are true, accurate, and complete in every respect. I understand that Program acceptance, if granted, is conditioned upon the veracity of my responses. If accepted, I will promptly notify Restoration House Staff if any information provided in this Application changes. I further understand that acceptance does not guarantee a specific entry date; my entry date will depend upon availability of bed space.”
Please sign in agreement with the above statement:

Clear
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

Restoration House Application

Section 2: Personal Background

Alcohol/ Drug Use

Gang Affiliation

Housing & Jobs

Finances

Relational

Other

Section 3: Criminal Justice Background

A. PENDING

B. CURRENTLY INCARCERATED

C. PRIOR CONVICTIONS

ALL APPLICANTS MUST COMPLETE: