Resident Application – Bridge to Stability Transitional Men’s Home
Please complete this application honestly to help us assess your fit for the program and your commitment to rebuilding your life.
Basic Information
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Current Status
Where are you currently staying?
*
Are you currently employed?
*
Yes
No
Where do you work?
How will you pay for your residency?
Are you actively seeking employment?
Yes
No
Recovery & Background
Are you currently in recovery?
*
Yes
No
Have you completed a treatment program?
*
Yes
No
If yes, how many days clean?
Are you currently on probation or parole?
*
Yes
No
If answered YES, to recovery, treatment program, or on probation please provide details. If answer NO please write N/A below
*
Readiness & Accountability
Why are you seeking transitional housing?
*
What are your goals for the next 60–90 days?
*
You understand this is a shared space?
*
Yes
No
Are you willing to follow house rules, including curfew and respecting staff and housemates?
*
Yes
No
Are you willing to live in a drug- and alcohol-free environment?
*
Yes
No
Program Fit (Screening)
Are you ready to commit to a structured and accountable living environment?
*
Yes
No
Do you understand that this is not a shelter, but a structured living program?
*
Yes
No
Emergency Contact
Emergency Contact Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
*
Submit Application
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