Forward Recovery Application
Sober Living Application
Before you begin, you must have read our Rules and Regulations. Provide as much information as possible. Let your efforts in this reflect your desire for recovery.
Applicant Details
I have read the rules and regulations for Forward Recovery, and I acknowledge I will agree to them if I am accepted into the program.
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Yes, I agree
No, I do not Agree
I need further clarfication
Date
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-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Current Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What type living situation is this?
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Home/ treatment/jail/ friends house/ect
Gender
*
Pronouns
*
How will you be paying your rent?
Self pay, funding agency, or do you need rental assistance?
Do you have a significant other?
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Do you understand that there is a one time $300 non refundable admin fee, and a monthly rent of $700 due on the 1st of every month?
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Yes
No
In order to "hold your bed" prior to moving in, 50% of move in cost is due up front to hold your place in our program. The $500 is non-refundable if you do not show up for your move in date.
I understand
Emergency Contacts
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Next
Addiction History
Do you consider yourself any of the following?
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Alcoholic
Drug Dependant/ Addict
Alcoholic/Addict
Drug of Choice
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Describe your history with mind altering substances.
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What are you doing for your recovery currently, or have you done in the past, that have been helpful to your recovery?
AA meeting/ NA meetings/ Faith Based Recovery/Holistic/Etc.
Sponsor's Name
Have you ever lived in a sober living environment? If so, please provide details.
Are you currently prescribed MAT service?
Yes
No
If you answered yes, verify what MAT services.
Suboxone/methadone/etc
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Treatment and Mental health History
Are you currently, or have you recently received treatment for your substance abuse disorder?
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When is your release date?
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Month
-
Day
Year
Date
Treatment Provider Info
Do you have a Mental Health Diagnosis?
Yes
No
If you answered yes to the previous question, list your diagnosis.
Are you enrolled in an Outpatient Treatment program? If so, where?
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Medical Conditions
List any medical conditions.
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List all allergies
*
Do you have any conditions that limit your mobility?
*
If you are unable to be employed, please give an explanation.
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Legal Information
Criminal History (check all that apply in your lifetime)
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I have no criminal history
I'm currently on city county or state probation
I'm currently on federal supervison
I have been convicted or charged with a violent crime
I have been convicted or charged with a sex crime
I have been convicted or charged with arson
I am on DOC
I am on ankle monitoring
I have a criminal history but am not currently on supervision
If you have criminal history, please give a brief explanation of the charges and circumstances.
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Probation Officer
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any history of Domestic Violence ?
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I have been, or am currently, a victim of domestic violence
I have charges or have pending charges, of domestic violence
No, I do not have any DV History
If you answered yes to any history of DV listed above, please describe.
*
Do you have a valid Driver's License?
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Yes
No
Do you have an operational car you will be using while living here?
*
Yes
No
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Employment
Work experience. What do you do for employment? Do you have any trades, skills, degrees, or trainings? What are your plans or goals for employment?
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Are you currently employed?
Yes
No
Other
What is your work schedule?
Days
Swing
Nights
My schedule varies
Not employed
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Recovery Healing Goals
What do you hope to accomplish by living in a sober living home?
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Do you have a certain timeline for staying in sober living? (example: 6 months until I can get my own apartment.)
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What are your goals in sobriety?
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Do you have a local support system in Spokane? Sober friends, supportive family, sponsor, etc? If not, how do you plan to develop one?
Thank you for your application. Submitting this application does not guarantee you will be accepted. You will be contacted in a timely manner for any follow up information, or to schedule an interview.
Submit
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