I Am Recovery Application
Program Overview:
Stages:
Stage 1 (Estimated 90 Days):
90Recovery Activities (Min 4 per week, covers various pathways like House Meeting, 12 Step, Clinical, Spiritual, etc.)
Recovery Mentor (Sponsor, Coach, Therapist)
Job
Stage 2 (Estimated 90 Days):
45Recovery Activities (Min 4 per week)
Commitment to a Recovery Program (e.g., 12 step, Refuge, Smart, LifeRing, etc.)
Weekly Group Participation in the chosen program
Be of Service to the recovery community or support for women in the community
Recovery Maintenance (Can continue indefinitely):
4 Recovery Activities per week
Maintain the requirements from Stages 1 and 2
Curfew:
10pm for 30 days
11pm for the rest of Stage 1
12am for Stage 2
No curfew during Recovery Maintenance
Overnights:
None for 30 days
1 per week for the rest of Stage 1
2 per week for Stage 2
3 per week during Recovery Maintenance
Guests:
None for the first 30 days
Family allowed during Stage 1
Female Friends during Stage 2
Men during Recovery Maintenance
Testing & Responsibilities:
Random UA’s (urinalysis tests) - 1 or 2 per week randomly during the stay
Nightly Breathalyzer tests (first 30 days)
1 Weekly Assigned chore
1 Weekly Assigned service hour
Fees:
Intake Fee: $220
Monthly Bed Fee: Starts at $950 for shared rooms, varies based on room type
Invoices due monthly on the date of move-in, $5/day for late invoice payments or payment plans
Invoices are non-refundable
30-day notice for move out required
What to Bring:
Food, Transportation, Clothes, Med Box, and Hygiene products
Locations:
Arvada West (64th and Kipling)
Denver (Federal and Alameda)
Englewood (Hampden and Federal)
Littleton (Bowls and Wadsworth)
Littleton West (Sims & Quincy)
After submitting an application, call us at: 720-432-3034
Click next to begin!
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?
Client race
What is your ethnicity?
Client ethnicity
What is your primary language?
Text field
What is your secondary language?
Text field
What is your gender?
Client gender
How do you identify?
Client pronoun
What is your marital status?
Client marital status
Are you a veteran?
Client veteran
Medical History
Tell us about your medical history.
When is your last date of use?
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
Do you have any previous Suicide Attempts? Dropdown
If Yes, what is the number of attempts: Text field
When was the last attempt: Date
Have you ever overdoesed? Dropdown
If Yes, how many times: Text field
When was the last attempt: Date
Do you currently suffer with or have you ever suffered in the past with an eating disorder? Dropdown
If Yes, please give further details: Paragraph
What date did you last actively engage in the eating disorder? Date
Legal History
Tell us about your Legal History.
In order to be considered for admission to I Am Recovery, LLC we will first run a background check. Do you agree to this? Dropdown
Are you currently on Probation? Dropdown
If Yes, when was the date of your last arrest: Date
What charges are pending? Paragraph
Are you currently on Parole? Dropdown
If Yes, what was your release date: Date
What charges were you convicted for? Paragraph
Are you a registered Sex Offender? Dropdown
Do you have any charges of Assault? Dropdown
Occupancy
What date are you looking to be admitted on?
Date
What is the estimated length of stay?
Client estimated length of stay