1.0 - Candidate Participant Application - Short Form Rev. 2026

The Better Path Foundation, Inc.

www.thebetterpath.org

Certified by and Member of

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Candidate Participant Short Form Application

Welcome to The Better Path Foundation, and thank you for taking the time to complete the Candidate Participant Short Form Application.

This Short Form Application helps The Better Path Foundation begin determining your eligibility to become a participant in our live-in recovery program and to be considered for placement in one of The Better Path Foundation’s recovery houses.

Please be aware that submission of this Short Form Application is only the first step in our intake process. After you submit it, a member of our team will contact you by email to request additional information and provide further documentation for completion. This additional information is necessary for us to better understand you and your current situation.

Saving and Returning to Your Application

If you are unable to complete the Application in one sitting for any reason, you may save your progress and return to it any time you are able.

To return to an Application you have started:

You must click the “Save for later” button before exiting.
After clicking “Save for later,” a unique link will be provided to you.
This link allows you to reaccess the same Application and continue where you left off.

We strongly recommend that you copy and paste the link into an email or a Word document and save it somewhere you will remember. You will need this link to return to your Application at a later time.

Please note that when you return to your saved Application using the provided link, the Application will appear as one continuous page, rather than the original multi-page format. If you need to save again, the “Save for later” button will be located at the very bottom of the Application, and the same identical link will be provided each time.

Completing and Submitting the Application

At the end of the Application, please ensure that you sign and date the form where indicated.

Once all sections are completed, scroll to the very end of the Application and click the “Submit form” button. After you click “Submit form”:

The Better Path Foundation will receive your Application.
You will no longer be able to access or reaccess the Application.

⚠️ IMPORTANT NOTICE
Incomplete Applications may not be reviewed or responded to. It is your responsibility to complete this Application as fully and accurately as possible in order for The Better Path Foundation to evaluate your request to be considered for our live-in recovery program.

If you do not hear back from The Better Path Foundation within a few days after submitting your Application, please do not submit another Application. Instead, email us at help@thebetterpath.org, and someone will respond to assist you as soon as possible.

Thank you again for taking the time to complete the Candidate Participant Short Form Application. We appreciate your interest and look forward to receiving your completed submission.

Sincerely,

Your friends at...

The Better Path Foundation, Inc.

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Candidate Participant Short Form Application

This Candidate Participant Short Form Application (the “Application”) is presented by The Better Path Foundation, Inc., a 501(c)(3) Wisconsin nonprofit corporation, together with its successors and/or assigns, as their interests may appear (hereinafter referred to as “TBPF,” “us,” or “our”).

The individual whose name appears under Applicant’s Full Legal Name below shall be referred to herein as the “Applicant,” “I,” “me,” “my,” “you,” “your,” and “their.”

The Applicant affirms that the contents of this Application have been fully read by the Applicant, or read to the Applicant, and that the Applicant fully understands all statements, questions, and requests for information contained herein. The Applicant further represents and warrants that, at the time of completing this Application, the Applicant is of sound mind and is not under the influence of alcohol, drugs, medications, or any other substances that would impair the Applicant’s ability to understand the statements, questions, and requests for information contained in this Application.

The Applicant acknowledges and agrees that all information provided in this Application shall be truthful, accurate, complete, and made honestly and to the best of the Applicant’s knowledge and belief.

By continuing with this Application, the Applicant acknowledges, understands, and agrees to the foregoing in its entirety.

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I. Personal and Demographic Information

Applicant’s Full Legal Name:

(First) Client first name

(Last) Client last name

(Middle) Client middle name

Generation, if any (i.e. Jr. or Sr., or II, III, IV) Text field

If you have been known by any alternate names or nicknames, please write in all such names below:

Client nickname

Date of Birth: Client birthdate

Social Security Number: SSN

Landline/Mobile/Cell Phone: Client phone

Email Address: Client email

---You must provide a valid, working, and accessible phone number and email address. Please carefully review and verify that both are accurate before submitting this Application, as inaccurate contact information may prevent us from being able to contact you.---

Instructions:

If the statements or questions below require a Yes or No answer, select either YES or NO. Otherwise, select and/or fill in the appropriate and correct answers to each statement or question, or request for information as provided herein below.

1. I, the Applicant, consent to be contacted by TBPF via SMS, email, phone, in person and/or any other means TBPF may deem approriate using the information provided in this Application for the purposes of reviewing my Application for consideration by TBPF for me to become a participant in TBPF's live-in recovery program and for possible placement in one of the TBPF recovery houses.

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2. I, the Applicant, agree and consent to a background check; which may be obtained at any time by TBPF; whether now or in the future, in TBPF’s sole discretion.

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3. Have you ever been convicted of...

a. a sexual crime?

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b. violent crime while sober?

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c. crime of arson?

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4. What is your personal relationship status (aka significant other status)?

Client marital status

5. What is your gender identity?

Client gender

6. What is your race/ethnicity?

Client race

Client ethnicity

7. Are you a United States veteran?

Client veteran status

Please Note...Social Security known as SSI, and Social Security Disability known as SSDI are different. If you receive either or both, please indicate in the next two questions below, if you are not sure, but you may be receiving some type of benefit from the Social Security Administartion, please select "Not Sure."

8. Are you receiving Social Security Income also known as SSI?

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9. Are you receiving Social Security Disability Income also known as SSDI?

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10. Are you currently employed?

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How do you plan to pay your TBPF fees and costs to enter and remain in the recovery house and recovery program? Please note, sober living in the State of Wisconsin is not free, and is not covered by insurance. There are funds from various organizations and government agencies, from time to time, that may help to cover a month or so, but not on a continual, never ending, basis. You must be able to explain your plan to pay your sober living cost and expenses in the space provided below.

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Please list all organizations and government agencies you have contacted or plan to contact for financial support.

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Do you have any family and/or friends that will financially support you?

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If you answered Yes to the question above, please list the name(s) of the person or persons who will be assisting you with financial support.

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Please Note, for question 10 above in total: If a third party may be paying for your sober living expenses or costs (including, but not limited to, any family or realtives, or any agency), you will be required to sign a reciprocal Release of Information authorizing us to communicate with whoever may be assisting you with payment.

11. Are you currently enrolled in school?

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12. What is the highest level of education you have completed?

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If you selected "Other" as an answer for question 12 above, please fill in what "Other" means:

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13. Do you have any professional licenses?

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If you selected "Yes" an an answer for question 13 above, please fill in what type of professional license(s):

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14. Who is completing the Application? (Select all that apply)

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If you select any answer to question 14 above, other than "I am," please write in the person's first and last name and a valid phone number to reach this party:

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15. Are you fleeing a domestic violence situation?

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16. Are you in the process of family reunification?

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17. Do you have any children?

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18. Are you pregnant or planning on becoming pregnant?

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II. TBPF Program Recovery House Details

19. All of our bedrooms at TBPF recovery houses are shared bedrooms; for accountability reasons...do you agree to have a roommate(s) if you are accepted into TBPF's live-in recovery program?

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20. Are you able to go up and down stairs on your own? (All of our recovery homes are at least two-story homes, and you must be able to accomplish this on your own; without anyone's help or assistance; whether you are walking up and down the stairs or carrying any items with you up and down the stairs)?

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21. You agree that you will do household chores:

a. As and when chores are assigned; which may include, but are not limited to, washing dishes, vacuuming, sweeping floors, mowing lawn, clearing snow from walkways and the driveway, landscaping, dusting, windows, etc.?

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b. timely without excuses

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c. and do chores well and to the satisfaction of TBPF and the House Lead; if there is a House Lead

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You understand, acknoweldge, and agree that NOT completing your chores as described above may lead to your being asked to leave TBPF's live-in recovery program?

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III. Current Living Situation and/or Rentry

TBPF understands that everyone has a unique journey. In order for TBPF to better understand your transition to TBPF's live-in recovery program, it is helpful to understand your current living situation.

22. What best describes your current living situation? (You may select more than one)

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If you selected "Other" as an answer for question 22 above, please fill in what "Other" means:

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23. If you have a physical location (such as an apartment, house, or trailer) as your current living situation associated with question 22. above, please provide your physical address:

Address: Text field

City: Text field

State: Text field

Zip: Text field

24. If you have no permanent place to live and you are currently experiencing homelessness, and you have a mailing address you use to receive mail, i.e. a PO Box, a friend’s or family member’s address, etc., please provide your mailing address below:

Address: Text field

City: Text field

State: Text field

Zip: Text field

and, whose address is this:

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Please answer Question 25 below only if you are currently incarcerated or if you are not currently residing in a treatment facility. Otherwise, please continue to the next section and proceed directly to Question 26.

25. You understand and agree that:

a. If you are currently incarcerated, in the process of release or reentry, or NOT presently in a treatment facility, you will be required to complete an ASAM Criteria Assessment through Phoenix Recovery, located in Madison, Wisconsin (this includes if someone may be homeless, or coming from another sober living home). The ASAM Criteria Assessment may be conducted either in person or virtually, at the discretion of Phoenix Recovery (In most cases, your health insurance will cover the cost of the ASAM Criteria Assessment).

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b. You further understand and agree that you will be required to sign a release authorizing Phoenix Recovery to provide the results of the ASAM Criteria Assessment to TBPF. The purpose of the ASAM Criteria Assessment is to assist TBPF in determining whether the level of support available through The Better Path Foundation is appropriate for your needs, or whether a higher level of care may be required. Completion of the ASAM Criteria Assessment does not guarantee acceptance into TBPF's live-in recovery program.

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IV. Emergency Contact Information and

Release of Information Contact(s)

Include at least one Emergency Contact. If you do not have someone to put down as your Emergency Contact, consider including your sponsor, peer support person, recovery coach, probation officer, parole officer, and/or case manager.

26. Who is your Emergency Contact? (This is who will be contacted in the event of an emergency)

Contact

27. What is the Emergency Contact’s relationship to you?

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28. Do you have any personal references to list below?

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29. If you answered Yes to question 28. above, please provide your personal references below:

Contact

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V. Substances Used

30. When you previously used substances, what was/were your substance(s) of choice?

(Please select all that apply - click inside of the box to make additional selections)

Client substances of choice

31. Do you vape?

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32. Do you use marijuana?

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Do you have a prescription for medical marijuana?

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If you answered "Yes" to either of the two questions in question area 32 above, are you willing to stop using marijuana or medicial marijuana?

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33. Do you use THC or CBD products?

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If you answered "Yes" to question area 33 above, are you willing to stop using THC and/or CBD products?

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34. Are you using any medication assisted treatment (MAT), i.e. Suboxone, Methadone, Vivitrol, etc.?

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VI. Health

35. Do you have any food allergies?

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If you answered "Yes" to question 35 above, please write in your food allergy(ies):

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36. Do you have seasonal allergies?

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37. Do you have any of the following clinical diagnoses?

(Please select all that apply - click inside of the box to make additional selections)

Client diagnosis

Also, have you been diagnosed with any of the following? (select all that apply)

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38. Do you have any health problems?

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39. If you answered Yes to question 38. above, do you have any of the following health problems?

(Select all that apply - click inside of the box to make additional selections)

Client health problems

40. Do you have any of the following:

a. Primary Care Physician?

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b. Psyciatrist?

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c. Therapist?

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VII. Recovery and Treatment

41. Are you currently in a treatment facility or treatment program?

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42. If you answered Yes to question 41. above, please provide the treatment facility or program details below.

Name of facility or program: Text field

Staff Contact Name: Text field

Facility or program phone No.: Text field

When did you start there: Text field

How long have you been there: Text field

Estimated discharge date: Date

Is this an inpatient or outpatient facility or program? (Select one):

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43. Have you been in detox recently?

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44. If you answered Yes to question 43. above, please provide the most recent detox facility details below (Please include details of any hospital or facility where you detoxed):

Name of facility: Text field

Staff Contact Name: Text field

Facility or program phone No.: Text field

When did you enter into detox? (Provide a date if known, or how many days or weeks ago, i.e. 17 days ago, 30 days ago, 5 weeks ago, etc.):

Text field

What were you there to detox from, what substance(s)?: Text field

45. What was the first date of your most recent recovery/recovery date (also known as your clean date or sober date)?

Text field

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VIII. Assistance

46. Do you have immediate needs such as clothing or toiletries?

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47. Do you need assistance with any self-help, support group and/or networks within the local community, i.e. peer support counselor?

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48. Do you need help to renew or obtain any forms of identification, i.e. driver's license, state identification card, etc.?

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49. Do you need assistance with any food programs?

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50. Do you need assistance with a Metro bus pass?

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51. Do you need assistance with applying for health insurance through Forward Health/Consortium?

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52. Do you need assistance with your resume; whether to write a new resume or freshen up your current resume?

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53. Do you need assistance with finding a job/work?

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Please Note: TBPF may work with, and refer you to, various third-party organizations that can assist you with some of the above, i.e. employment-related needs, including job searches, résumé preparation, and related support services. However, TBPF does not secure employment on your behalf. If approved for and admitted into TBPF’s live-in recovery program, you will be required to obtain and maintain employment shortly after entry into the program, in accordance with program requirements concerning productive activity.

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IX. Legal Matters

54. Do you have a Probation Officer?

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If you answered Yes to question 54., what is your Probation Officer's name and phone number?

Probation Officer's Name: Text field

Probation Officer's phone number: Text field

55. Do you have a Parole Officer?

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If you answered Yes to question 55., what is your Parole Officer's name and phone number?

Parole Officer's Name: Text field

Parole Officer's phone number: Text field

56. Do you have a Pretrial Services Officer?

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If you answered Yes to question 56., what is your Pretrial Services Officer's name and phone number?

Pretrial Services Officer's Name: Text field

Pretrial Services Officer's phone number: Text field

57. Are you currently involved in any legal proceedings or criminal justice issues?

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58. Do you have a requirement to perform Community Service?

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59. Do you have any court ordered treatment requirements?

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60. Do you have any pending sentencing or possible jail time upcoming?

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61. Are you required to register with any authority for any reason?

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62. Are you on or required to register with the National Sex Offender Registry?

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63. Are there any restraining orders against you?

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64. Are there any restraining orders filed by you against anyone?

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65. Have you been charged or convicted of a felony?

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66. Have you been charged or convicted of arson?

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67. Have you ever commited a violent crime while you were sober?

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68. Do you have any legal requirements to adhere to?

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69. If you answered Yes to question 68. above, select all legal requirements that apply:

(Select all that apply):

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If you have a legal requirement for something other than is listed above, enter it here: Text field

70. Are you currently incarcerated?

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71. If you answered Yes to question 70. above, in what facility are you currently located?

(i.e. FCI Oxford, WI…Oakhill Correctional Institution, Oregon, WI, etc.)

Facility name and location: Text field

What is your expected release date? Date

What is your Case Manager’s name? Text field

What is your Case Manager's phone number or the facility's phone number; if available to you? Text field

What is your Case Manager's email address at the facility; if available to you? Text field

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IX. Recovery House Info

72. If you are approved to be a participant of TBPF's live-in recovery program, by what date would you like to move in:

Date

73. Do you have a personal relationship with anyone who lives in a TBPF recovery house, or with any TBPF staff or volunteers?

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74. Do you acknoweldge, understand, and agree that in the event you are accepted into TBPF's live-in recovery program, as a TBPF participant, there are TBPF rules that must be followed, and failure to follow the TBPF rules may lead to your being removed from the TBPF recovery house and program?

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X. Transportation

75. Do you have a valid driver's license?

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76. If you answered Yes to question 75. above, do you have a vehicle you drive? (i.e. may be owned, borrowed, or rented)

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77. If you answered Yes to question 76. above (Plerase note...Any vehicle you drive while you are a TBPF participant must have a valid auto insurance policy of insurance connected to it with TBPF added to the insurance as a party of interest):

a. Do you have valid automobile insurance?

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b. Does the owner of the vehicle you borrow have valid automobile insurance?

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c. Does the vehicle you rent have valid automobile insurance?

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78. If you answered No to question 75. above, do you have a State issued identification card?

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79. I understand that some form of a photo ID/Identification must be presented by me to TBPF staff on the day of intake in the event I am approved to enter TBPF's recovery program? This may be a driver's licnese (and should be if you have one), State ID (if a driver's license is not avaiable, if you have a State ID), identification from a facility you may have been released from, i.e. prison, treatent facility, etc (if a driver's license or State ID is not available).

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XI. General

80. I understand, acknowledge, and agree that I shall participate in any programming offered at the recovery house; when offered, as being a participant of TBPF's live-in recovery program, and acknowedlge there are no exceptions made to participation when programming is made avaiable?

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81. I understand I must have a smartphone cellphone device (Android or iPhone) with active Internet service; which permits apps or applications to be downloaded upon the smartphone? TBPF utilizes an electronic program which must be able to be downloaded on your smartphone device; which stays connected through the Internet service.

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82. I understand, acknowedlge, and agree that I will be responsible for nightly curfew checkins and any checkins for any recovery based meetings I attend using the electonic program mentioned in question 81. above.

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83. I understand, acknowedlge, and agree that I must have a valid, working, accessible email address to be admitted to TBPF's recovery program should I be approved for entry (In the event I do not have an email address, I understand that I will ask someone for assistance to help set up an email address for me and show me how to use it; prior to coming to the recovery house for my intake).

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84. I understand, acknoweldge, and agree that TBPF does not permit its participants to work night shifts and/or 3rd shifts past curfew.

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If you answered Yes to questions 84. above, I further understand, acknowedlge, and agree that if I am to obtain employment, I must obtain employment where I am inside the recovery house by the required curfew time and do not leave the recovery house until the posted time; based on the TBPF Tier level I am on.

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85. Please answer the following questions:

a. Do you have a peer support person?

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If you answered Yes to 86.a above, please enter the name and phone number of this party:

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b. Do you have a sponsor?

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If you answered Yes to 86.b above, please enter the name and phone number of this party:

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c. Do you have a recovery coach?

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If you answered Yes to 86.c above, please enter the name and phone number of this party:

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86. How did you hear about TBPF, or who referred you to TBPF? (Write in your answer)

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Please provide their contact phone number and/or email address.

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Applicant Statement of Fact

I, the Applicant, acknowledge and agree that I have read this Application, or I have had this entire Application read to me. I warrant and represent that I fully understand all of the statements and questions, and requests for information in this Application in order to have entered my answers within this Application; providing all my answers and information with accuracy, truthfully, and to the best of my knowledge.