THE BEACON APPLICATION (Sherman Hill Program & Village Apartments)

PROGRAM DESCRIPTION 

The Beacon operates two sober living recovery supportive housing programs. Both programs are fully substance free and support long term stability, healing, and independence. The main differences between the programs are the level of structure and the financial expectations.

The Beacon at Sherman Hill
NARR Level IIA. Sherman Hill is a structured sober living program designed for women seeking accountability, routine, and a supportive recovery community. Residents participate in weekly case management, three weekly recovery or wellness meetings, shared chores, weekly House Meetings, and curfews based on program phase. Substances are not allowed on site, and relapse is addressed through supportive planning and accountability.
A program fee of 105 dollars per week is required and must be paid on time. Sherman Hill is a good fit for individuals who need structure and community support as they build stability and recovery skills.

The Beacon Village
NARR Level II. The Beacon Village offers long term independent apartment style housing for women who are stable in their recovery and ready for more independence. Residents are responsible for maintaining their apartment, managing their schedule, and participating in weekly case management and ongoing wellness and recovery activities.
Residents at The Village sign a lease and are responsible for paying monthly rent on time, with the amount based on the apartment they choose. Emotional support animals are permitted with proper ESA documentation and updated vaccination records. The Village is a good fit for individuals with income who want independent housing while continuing to receive supportive services.

Welcome to The Beacon intake wizard
Click next to begin!

General Information

Tell us about yourself
Who is completing this form
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Do you have the applicant’s permission to submit this referral
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What is your relationship to the applicant
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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
Do you socialize and identify as female?
Checkboxes
What is your marital status?
Client marital status
Are you a veteran?
Client veteran
 

Program Placement Questions

Beacon program are you most interested in or open to
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Please describe why you prefer this option Enter NA if not applicable
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Substance Use History

Have you used alcohol illicit substances or non prescribed medications in the last 30 days
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Please provide details Enter NA if not applicable
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Have you used substances in the last 60 days
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Please provide details Enter NA if not applicable
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Have you used substances in the last 6 months
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Please provide details Enter NA if not applicable
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Both Beacon programs are sober living recovery residences Substances are not permitted on site and relapse is addressed with support safety planning and accountability Are you willing to live in a sober living environment
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Please share anything that would help us support you Enter NA if not applicable
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Housing Stability Screening (HUD-Aligned)

Are you experiencing homelessness housing instability or fleeing domestic violence

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HUD defines homelessness as sleeping in a shelter on the street in a vehicle or in any place not meant for housing staying in a hotel or motel due to lack of other safe housing couch surfing staying with others due to loss of housing being at immediate risk of losing your housing or fleeing domestic violence sexual assault stalking human trafficking or any unsafe situation.


Please describe your current living situation Enter NA if not applicable
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The Beacon is a long term 6 to 24 month recovery supportive program Are you looking for long term housing and structured support
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Please explain your goals Enter NA if not applicable

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Are you seeking long term stable housing, like The Beacon Village, where you can remain as long as you meet rent or program expectations?
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What does long term stability mean to you Enter NA if not applicable
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Do you currently have legal income?

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Please explain:

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Income Eligibility Screening 


The Beacon serves women whose income is at or below 30% of Area Median Income (AMI) at the time of admission. This helps make sure our housing and services are available to those with the greatest need. Income will be verified during the intake process.

What does 30% AMI mean?
It means your income is at or below the amounts listed below for Polk County, Iowa.

Yearly income limits (before taxes):

1 person household: $24,060 or less per year
2 person household: $27,480 or less per year
3 person household: $30,930 or less per year
4 person household: $34,350 or less per year
If you are not sure, that is okay. Our team can help you figure this out.


What is your current household size?
Only include people whose income you share or file taxes with.

Number field

What is your current gross monthly income (before taxes)?
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What is your current gross yearly income (before taxes)?
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Based on the information above, do you believe your income is at or below 30% AMI for your household size?
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If you selected “Unsure,” please share anything you would like us to consider:
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Acknowledgment
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Recovery Expectations


Are you actively seeking support to build stability after experiencing addiction trauma mental health challenges or major life disruption
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Are you open to participate in weekly case management meetings
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At The Beacon Sherman Hill, residents participate in recovery wellness or mental health based meetings three per week at Sherman Hill and at least one per week at The Village Are you willing to meet this?
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Do you feel ready to begin a structured healing and recovery journey with accountability and community
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Contact Information

How can we reach you?
What is your email address?
Client email
At what phone number can we best reach you at?
Client phone
 
Most Rent Address (Where did you live last?)
City:Client City
State:Client State
Zip code: Client Zip
 
Current Location (Where are you today?)
 
City:
Client City
State:
Client State
Current Zip code:
Client Zip

Contacts

Give us a few people that we can reach out to in case of an emergency.
Contact
Anything we need to know? Text field

RENT & FEE QUESTIONS

The Beacon at Sherman Hill requires a weekly program fee of 105 dollars that must be paid on time. Are you willing and able to pay the weekly program fee
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The Beacon Village requires signing a lease and paying monthly rent. Are you willing and able to sign a lease and pay monthly rent on time

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Do you currently have income that can reliably cover either the weekly program fee or monthly rent depending on placement

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Please describe your income source Enter NA if not applicable

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READINESS & GOALS

Sherman Hill requires participation in structured community living with weekly program fees. The Beacon Village requires independent apartment living with a lease and monthly rent responsibilities. Which environment do you feel prepared for today

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Are you looking for short term structured housing or long term independent housing where you can remain as long as you follow lease and program expectations

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Insurance

Enter your insurance provider(s).
Insurance
Checkboxes

Medical History

Tell us about your medical history.
When is your last day of use (substance/opiod/alcohol/unsafe behavior)
Date
When was your last relapse date?
Recovery history 1 relapse date
What is your substance(s) of choice? Add multiple by clicking in the box and selecting different options
Client substances of choice
Have you been clinically diagnosed with anything? Add multiple by clicking in the box and selecting different options
Client diagnosis
Do you have any health problems? Add multiple by clicking in the box and selecting different options
Client health problems
What kind of meetings do you attend? Add multiple by clicking in the box and selecting different options
Client kinds of meetings attended
What allergies do you have? No allergies? Move on to the next question.
Client allergies

Have you had any of the following tests?

Medical Tests
 

Medications

List the medications you are currently prescribed.
Medication

Treatment Centers

Tell us about any treatment centers you've previously been admitted into.
TreatmentCenterHistory

Client Referral Source

Who referred you to us?
Client Referred By

Occupancy

 This part of the application for ONLY for an application is moving into a treatment center, inpatient center, etc. prior to their stay at one of our campuses
What facility will you applying to stay at?
Client facility

Sober Living History

Tell us about any sober livings you've previously been admitted into.
SoberLivingHistory

Employment

Tell us about your employment status.
If you're currently unemployed select "unemployed" under "type"
EmploymentHistory
 

Income & Financial Wellness Measurement (used for data)

What is your current monthly income (to the best of your knowledge)? Number field 
What is your current yearly income (to the best of your knowledge)?  Number field 
Do you have a savings? Checkboxes How much does it hold? Number field

Living Arrangement

Tell us about your living arrangement prior to moving into our location
LivingArrangementHistory