Prescreening Renal Questionnaire (Room For Rent)

A little about who we are and what we provide:

We start with one basic concept..."LIVE TODAY FOR A BETTER TOMORROW" - With this mentality, we offer a comprehensive program that supports multiple paths to recovery/sobriety and empowers residents for lifelong success.

We provide peer support services to help residents set personal goals, identify recovery paths, set personal goals, and develop a plan for achieving them.

We partner with local employment agencies and educational paid programs that provide services in job readiness to enhance the opportunity for residents to become skilled, career-driven, and gainfully employed.

Additionally, we offer a weekly financial literacy course with a professional financial strategist, helping residents rebuild financial stability to prepare for independent living.

Today Transitional suggests each resident volunteer once per month with a community service organization who assists the less fortunate as a way of giving back.

We take a holistic approach to enhance the resident's mental, physical, emotional and spiritual well-being by learning basic life skills. Today Transitional will offer motivational speakers and workshops on anger/stress management, regular exercise regime, and meditation. (In-house)

By providing these resources along with experts in their field we believe residents can transition to a new life feeling confident and equipped for a successful future. The key is living today for a better tomorrow.

OUR MISSION:

Our mission at Today Transitional Living is to provide a safe and supportive environment for individuals committed to living a sober lifestyle. By focusing on living in the present moment and making positive choices today, our residents can create a better tomorrow for themselves and those around them. We strive to offer personalized care, educational resources, and a sense of community that empowers our residents to achieve their goals and build a foundation for a successful and fulfilling future

> Introduction <

Please use this space (and more if you would like) to take the time to introduce yourself to - Today*

First and Last Name*

Date of Birth

Date

Phone Number*

Social Security Number*

E-mail*

example@example.com

Please provide any additional Contact info (name/phone numbers where you can be contacted and put an (*) by the contact that should be your emergency contact - *

Are you currently employed?*

YesNo

Employer Name and phone number

Marital Status:

SingleMarriedDivorcedWidowed

Does your significant other struggle with an addiction?*

YesNo

If "yes" to above are they safe and sober?

Do you have any children?

YesNo

If "yes" above, please list their names and dates of birth:

Who do your children live with?

Do you have an open DCS case?

YesNo

If "yes" above, please list the Case Manager's name, county, and any contact information:

Have you ever been incarcerated?

YesNo

If "yes" above, please explain briefly, and provide your person of contact along with their name and phone number *

Do you have any pending Charges? (Please list all details including the charge and county)

Please provide the name and all known contact info for this person:

Have you completed detox or treatment anywhere? *

When were you discharged?

If "yes" above, where and please provide points of contact

How long have you been sober?

What is your path to recovery?

(AA, NA, Smart Recovery, Celebrate Recovery, CA, HA etc.)

Sponsor's Name:

Who are your supports?

Are you on any type of supervision?

>Substance Abuse History <

Please explain the progression of your addiction - (When did it begin and with what substance?)

What one piece of advice would you give your sober self?

What are your triggers?

What are 3 weaknesses you have? (feel free to elaborate on how you would like to work on these)

What are 3 strengths you have?

Please list 3 Goals: (2 short term goals & 1 long term goal)

How long do you plan to reside in a Today Transitional Living home?

Today Transitional Living is a Sober/Recovery Home for Women that is warm, inviting, carefully designed, and decorated to comfortably house six to twelve women. We take pride in the thoughtful details we’ve integrated

to offer the most pleasant and affordable living arrangement to those in need of safe/suitable housing. It was not established to allow women the benefit of living in it for free. All residents who are selected to join the Today Transitional Family will be expected to maintain its beauty and charm by providing their share of the financial responsibility to keep it running smoothly so it will be available for those who may need it in the future.

Thank you for taking the time to apply and we will be in touch with you after we review!