Application for PorchLight Recovery Sober Living
Congratulations on making a choice to continue your journey at Porchlight Recovery's sober-living community in downtown, historic Lanaster, PA! We encourage you to complete this application early, as space is limited, and we review applications in the order they are received. For assistance, please email or call 833-799-6500. Please allow 24 hours for review of all applications.
General
Tell us about yourself
What is your first name?
Client first name
What is your middle name? No middle name? Move on to the next question.
Client middle name
What is your last name?
Client last name
When is your birthdate?
Client birthdate
What is your race/ethnicity?
Client race
What is your gender?
Client gender
What is your marital status?
Client marital status
Are you a veteran?
Client veteran status
Occupancy
What date will the you be beginning residency at PorchLight?
Date
What is the estimated length of stay?
Client estimated length of stay
Thank you for completing the application! Please sign and date the bottom to complete this form: