• BUTTERFLY MOMENTS WOMEN'S RECOVERY HOUSING APPLICATION

    SUBMISSION OF APPLICATION DOES NOT GUARANTEE ACCEPTANCE
  • The program is Tennessee Department of Corrections Approved housing providing Addiction Recovery Program Supports.  The program length is three to six months with the opportunity to stay longer if court ordered or needed for sustained recovery.  

    Financial Responsibility

    1. There is no application fee. If accepted, your final approval will begin upon receipt of nonrefundable $200 program administration deposit and two weeks program fees ($480.00 due upon acceptance). 

    2. Fees are $140.00 per week or $560.00 monthly in advance nonrefundable. 

    3. Any fees paid in advance will not be refunded and will be forfeited if you move or violate rule resulting in discharge.

    4. Scholarship opportunities may be available.  Please inquire.

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  • APPLICANT INFORMATION

    TOMIS #_________________________
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  • EMERGENCY CONTACT/REFERENCES

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  • Release information to this person? *

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  • Release information to this person?

  • CRIMINAL HISTORY

  • Acknowledgement of responses

    Read thoroughly before signing
  • I hereby certify that the answers I have given in the application are true to the best of my knowledge. By signing below, I agree to abide by all legal agencies and program rules with the full knowledge that willful failure to comply will result in my discharge with loss of all deposits and/or prepaid program fees. I understand I am not entering into a lease.  I am entering into a program which requires participation, or I will be asked to leave the property.  I agree that I will in no way hold the Owner/Director or occupants of Butterfly Moments Inc. in any way responsible for any injuries or even death that may occur during program participation. I also give my consent for staff (or designate) to contact my listed references, family members, sponsor(s) and/or Probation/Parole Officer concerning my progress or welfare.  I agree to a background check if deemed necessary. It is understood that I will not be discriminated against based on race, color, sex, religion, or national origin. 

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  • BUTTERFLY MOMENTS INC. WOMEN'S RECOVERY CENTER

    phone: (931) 802-9133 email: office@butterflymomentsinc.org 865 Gracey Avenue, Clarksville, TN 37040
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