• New Life Sober Living - Providence Application

    Submission goes directly to newlifesoberhouse.com@gmail.com
  • Birth Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date Applying (Today)
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Relationship Status*
  • Gender*
  • Are you currently enrolled in treatment or support program?*
  • Format: (000) 000-0000.
  • Are you in recovery?*
  • Date of last use*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you currently participating in AA or NA meetings?*
  • How will you pay for program fees?*
  • Have you ever been convicted of a felony?*
  • Are you on parole or probation?*
  • Format: (000) 000-0000.
  • Are you legally mandated to registration requirements?*
  • Have you ever been convicted of arson?*
  • Are you legally mandated to live in a sober house?*
  • Do you own a car?*
  • Do you currently take any prescription or over-the-counter medications?*
  • Are any of your medications controlled substances (e.g., benzodiazepines, stimulants, narcotics)?*
  • Please list all your current medications below.
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  • Applicant Statement (Please read before signing)

     

    I hereby authorize New Life Sober Living and its designated agents to conduct a review of my background including income, housing, treatment, criminal history, or any other public records. I authorize any individual, company, or public agency to release any information, verbal or written, pertaining to me, to New Life Sober Living or its agents. I will allow a photocopy or scanned image of this authorization to be as valid as the original. I understand that New Life Sober Living is a structured recovery house and not a rental property. I am applying for residency in this community-based house and, if accepted, I will be granted a revocable license to occupy a program bed as long as I remain in compliance with the rules, policies, and expectations set forth in the New Life Resident Handbook. I acknowledge that this is not a landlord-tenant arrangement, and that my occupancy is contingent upon ongoing participation in the recovery house. New Life Sober Living reserves the right to discharge any resident who violates house rules, without the need for formal eviction proceedings.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: