1.) Screening Application

Sober Living Application

Saint Paul Spirit is a spiritually based, 12 step abstinence program. There are mandatory house commitments on Sundays. No 3rd shift employment allowed. To apply for residency please fill out the form below.

First Name: Client first name 

Middle Name: Client middle name 

Last Name: Client last name

Phone Number 
Client phone
What is your Sober Date? 
Recovery history 1 sobriety date
Move-in Date 
Will you be driving? 
 Text field
Are you licensed and insured?: 
Radio buttons
Email: Client email
Current or most recent treatment center? 
Will you be attending outpatient treatment? Yes or no, if yes where? 

Radio buttons

What is your drug(s) of choice? 
Client substances of choice
What medications do you take?