North Star Initiative
The Harbor Residential Program
Please be advised that The Harbor is not resourced to provide services for a participant who meets any of the following conditions. We are unable to accept your participant if she:
Has fewer than 30 days clean
Has children who will be living with her
Is not ambulatory
Is not biologically female
Is prescribed narcotic medication
Is unable to self-manage
If any of the above are true of the applicant, we encourage you to seek alternative placement.
This form provides introductory information to assist NSI and The Harbor staff in determining whether the applicant is an appropriate participant for admission to our residential program. We ask that all information be completed in a concise, thorough manner and the application submitted for review before any determination of acceptance into the program is made.
Completion of this application assumes the participant consents to allow the Referring Agency to provide this information in consideration for her residency at The Harbor. We do not discriminate based on the responses provided on this form. Your candid, factual, and complete responses assist us in proceeding with the referral process.
ALL INFORMATION WILL BE KEPT CONFIDENTIAL