Sober Living Application

Rising Above Recovery Home Application
Thank you for expressing your interest in Rising Above Recovery Home. We regret to inform you that, at this time, our program is unable to accommodate children, spouses, or pets.

However, we are constantly striving to improve our services, and we hope to be able to offer these accommodations in the near future. We understand that our housing solution may not align with everyone's needs, and we appreciate your understanding.

Should you have any additional inquiries, please feel free to reach out to us directly at 918-954-3329.
Are you homeless?
What type of housing are you or the client applying for?
Do you own a vehicle?
Are you aware that this is for shared housing?
Full Name

First NameLast Name
Middle Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Last 4 digits of Social Security Number
Driver's License Number or ID Number
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are you currently sober?
Date of last substance use (if applicable)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Briefly describe your sobriety journey and goals.
Have you been convicted of a crime? That won't disqualify you.
Have you been through detox?
If so, when and where
If you receive SSI, SSDI, Veteran Benefits, Private Pay, or Other for payment
Medication-Assisted Treatment MAT/MOUD

Other
Medication-Assisted Treatment MAT/MOUD Reply
Why are you seeking sober living at this time?
Do you have a case manager?
Case Manager Contact Information
Are you currently receiving counseling, therapy, psychiatric care, or other mental health services?
Which mental health conditions have you been diagnosed or treated for?

Other
Please explain.
Provider's name
Agency/practice
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
How often do you attend?
Have you ever been diagnosed by a qualified healthcare professional with any of the following?
If yes or unsure, please explain what support or reasonable accommodation may help you.
Are you willing to continue recommended mental health treatment and follow your provider's treatment plan while residing at Rising Above Recovery Home?
Are you currently experiencing symptoms that may affect your ability to live safely and independently in a shared recovery residence?
Are you currently attending meetings?

Other
Do you have a sponsor?
Providing a provider’s information does not authorize Rising Above Recovery Home to contact that person. A separate written release of information must be signed before communication occurs.
Do you have insurance?

Other
Should be Empty:

Rising Above Recovery Home Application