Hansen Foundation Recovery Housing Application

Hansen Foundation Recovery Housing Application

Thank you for your interest in our recovery residences. Please complete this form, and one of our staff members will be in touch!
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Cell Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Current Living Situation*
Have you ever resided in sober living before?*

YesNo
Please list all of your diagnoses (mental health, medical)*
What medications are you currently taking?*
What is your criminal history?*
Are you currently in IOP or OP treatment anywhere? If not, what are your plans to enroll in IOP or OP treatment?*
Do you have the $600 move-in fee that would cover your first 3 weeks of rent?*

YesNo
Are you employed?*

YesNo
If employed, where are you employed?
If not employed, what are your plans to pay rent of $200 per week?
By signing below, you agree that you have read and understand the terms and conditions

Clear
- Rent is due every Tuesday.
  Rent is $200 per week.
  
  Phase Program:
  *All phase transitions are subject to staff discretion.
  
  Phase I:
  Restrictions:
  Must attend 6 sober support group meetings per week when unemployed.
  Must attend 4 sober support group meetings per week when employed.
  Curfew is 10pm, 7 nights a week.
  No visitors allowed aside from family and sponsor.
  Requirements to phase up to Phase II:
  Must obtain a sponsor and home group.
  Must secure full-time employment or:
  Full-time student
  Volunteer a minimum of 20 hours per week.
  *Retired/Disabled/FMLA Residents Excluded.
  Must reside in residence for a minimum of two weeks.
  Must be current in rent.
  
  Phase II:
  Restrictions:
  Must maintain sober support group meeting attendance as outlined above.
  Curfew is 11:30pm, 7 nights a week.
  Allowed 1 sleep-out per week.
  Must follow Sleep-Out policy (see below)
  Visitors are allowed.
  Must follow Visitor Policy (see below)
  Must maintain employment, student status or volunteer hours as outlined above.
  *Retired/Disabled/FMLA Residents Excluded.
  Must maintain having a sponsor and a homegroup as outlined above.
  Must remain current in rent.
  Requirements to phase up to Phase III:
  Must begin step work with a sponsor.
  Must obtain a service commitment through a sober support group.
  Must reside in residence for a minimum of 60 days.
  Must be current in rent.
  
  Phase III:
  Restrictions:
  Must maintain sober support group meeting attendance as outlined above.
  Curfew is 11:30pm Sunday through Thursday and 1:00am on Friday and Saturday
  Allowed 2 sleep-outs per week.
  Must follow Sleep-Out policy (see below)
  Visitors are allowed.
  Must follow Visitor Policy (see below)
  Must maintain employment, student status or volunteer hours as outlined above.
  *Retired/Disabled/FMLA Residents Excluded.
  Must maintain having a sponsor and a homegroup as outlined above.
  Must remain current on rent.
  Requirements to phase up to Phase IV:
  Must complete Step 1 with a sponsor.
  Must volunteer a minimum of 5 hours per month (in addition to previous volunteer hours)
  Examples of volunteer activities could include providing housemates rides to meetings, job interviews, medical appts, the grocery store, participating in Farm Community Day, Angels in Motion, etc.
  Must reside in residence for a minimum of 6 months.
  Must be current in rent.
  
  Phase IV:
  Restrictions:
  Must maintain sober support group meeting attendance as outlined above.
  Curfew is 12:00am Sunday through Thursday and 2:00am on Friday and Saturday
  Allowed 3 sleep-outs per week.
  Must follow Sleep-Out policy (see below)
  Visitors are allowed.
  Must follow Visitor Policy (see below)
  Must maintain employment, student status or volunteer hours as outlined above.
  *Retired/Disabled/FMLA Residents Excluded.
  Must maintain having a sponsor and a homegroup as outlined above.
  Must remain current on rent.
  Must maintain a minimum of 5 volunteer hours per week.
  Visitors to Serenity House:
  There are no overnight visitors to the Serenity House.
  Visiting times are from 10:00 am until 10:00pm.
  All visitors must have at least 30 days clean and are subject to a urine drug screen.
  Residents must be on Phase II or higher to have visitors.
  
  Overnights:
  Residents must notify the house lead and staff by 9pm if they plan to sleep-out.
  Residents must provide staff with the address and contact number of where he/she will be sleeping.
  Residents are not permitted to sleep at other Serenity Houses.
  Residents’ sleep-out restrictions are contingent upon which phase they are on.
  
  Sober Support Group Meetings:
  If unemployed, Resident must attend six sober support group meetings per week.
  A maximum of two of the required six meetings are permitted to be virtual.
  If employed, Resident must attend four sober support group meetings per week.
  A maximum of one of the required four meetings are permitted to be virtual.
  
  House Duties:
  There will be a rotating chore chart which Residents of the house will each have a chore that they will be responsible to perform according to chore schedule.
  
  Evictions:
  This Eviction Policy governs residency at Serenity House, a Class F Cooperative Sober Living Residence in New Jersey. It establishes standards to maintain a safe, sober, and cooperative living environment. As a Class F cooperative sober living home, Serenity House does not establish a landlord-tenant relationship with residents. All residents are non-lessee occupants and are not entitled to tenant protections under the New Jersey Anti-Eviction Act (N.J.S.A. 2A:18-61.1) or other housing statutes applicable to conventional rental agreements.
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