Disruptive Behavior Contract

Xchange Recovery Contract for Disruptive Behavior/Non-Compliance
Member under contract: *

First NameLast Name
House: *
Case Manager: *
This contract is:*

1st (verbal warning)2nd (documented)3rd (last chance)
This contract is designed to help you help yourself. I or your housemates have observed the following behaviors and/or patterns that are either disrupting the smooth operation of the house, or not conducive to your recovery.
Disruptive Behaviors:*
The house is asking you to modify your behaviors in the following way in order to best facilitate your recovery and the recovery of everyone in the house.
Specific Behavior Changes:*
I acknowledge and accept full responsibility for my plan of recovery as outlined in this contract. I understand and accept that failure to comply with the terms of this contract may result in this contract being modified or extended, and may also result in my expulsion from the Xchange housing program.
This contract will be reviewed as follows:*

1 week2 weeks3 weeks4 weeksWeekly checksTo conclude contract satisfactory and behavior has been modifiedTo extend the contract or add stipulationsOr to expel the resident for disruptive behavior
Follow up date: *

MonthDayYear
Date
Residents signature:

Clear
Printed name:*

First NameLast Name
Signed by housing team member:

Clear
Printed name:*

First NameLast Name
Should be Empty:

Xchange Recovery Contract for Disruptive Behavior/Non-Compliance