Potential Resident Application

Phoenix Recovery House Resident Application

Referral Process:

Applications are reviewed weekly by the Advisory Committee. Once applications are reviewed, candidates will be contacted to schedule the first round of interviews with the director, care coordinator, and current residents. If candidates advance to the next round, they will interview with staff and review any requested supporting documentation. Candidates will be notified of their selection status within one week after their interview.

Disclaimer:

The information collected through our intake process is used solely to create a personalized recovery plan tailored to meet the specific needs of each resident. The Change Initiative is committed to providing a supportive and inclusive environment. We do not discriminate on the basis of race, religion, age, national origin, sexual orientation, gender identity, or any other characteristic. Our facility is inclusive of all womxn, embracing and supporting the diversity of our community.

Please note, due to the presence of children within the home, we are unable to accept candidates who are required to register as sex offenders. This policy is in place to ensure the safety and well-being of all residents, including the children living in our facility.

We value the privacy and dignity of each individual seeking help at The Phoenix Recovery House and are dedicated to fostering a safe, respectful, and healing environment for everyone.

Program Overview of The Phoenix Recovery House

At The Phoenix Recovery House, we are committed to helping women reclaim their lives from addiction through a structured and intensive 12-month residential program. This program is meticulously designed for women who are ready to embark on a transformative journey towards sustained sobriety, personal growth, and improved quality of life.

Our Approach:

Our approach is rooted in evidence-based and trauma-informed care, ensuring that we address both the symptoms of addiction and its underlying causes. We understand that recovery is a comprehensive process that involves more than just abstaining from substances; it requires a deep, personal transformation and a commitment to develop new ways of living.

Program Structure:

The journey at The Phoenix Recovery House is divided into four progressive phases, each phase building upon the last to provide a thorough foundation for recovery and personal development:

- Initial Stabilization and Assessment: Upon arrival, residents undergo a detailed assessment to establish a personalized recovery plan. This phase focuses on stabilization, understanding each resident's unique challenges, and integrating them into the daily routines of the house.

- Core Recovery and Skill Building: Residents engage in daily activities that reinforce sobriety through structured 12-step meetings and therapeutic interventions. Simultaneously, we emphasize skill-building in areas such as emotional regulation, financial literacy, and job preparedness to equip our residents for life beyond our walls.

- Advanced Therapeutic Engagement: This phase delves deeper into the psychological aspects of addiction. Residents receive intensive therapy to address and heal from trauma, and they continue to develop more complex life skills that facilitate personal independence and resilience.

- Reintegration Preparation: In the final phase, we focus on preparing residents for reintegration into society. This includes solidifying recovery gains, advancing career or educational plans, and strengthening community ties and support networks.

- Commitment to Recovery: Admission to The Phoenix Recovery House is a commitment to participate actively in a challenging yet rewarding process. We seek residents who are ready to engage fully with all aspects of our program, from the rigorous daily routines to the deep personal introspection required for true change. Our goal is to empower each woman to not only achieve sobriety but also to thrive in her personal and professional life after graduation.

Rate your level of commitment to this program structure 1-10 (1 being not committed and 10 being completly committed):

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CONTACT INFORMATION:

Full Name: Client first nameClient middle nameClient last name

Nickname: Client nickname

Current Facility: TreatmentCenterHistory

Referred By: Client Referred By

Phone Number to be Reached: Client phone

Email Address to be Reached: Client email

Expected Discharge Date: Date

CANDIDATE INFORMATION:

Date of Birth: Client birthdate

Driver's License #: Text field

Martial Status: Client marital status

Do You Have Children: Text field

Name & Age of Children: Text field

Do You Have Custody/Will You Be Pursuing Custody: Text field

List any child welfare history: Child Welfare History

Highest Level of Education: EducationHistory

Employement History: EmploymentHistory

RECOVERY INFORMATION:

Sobriety Date: Date

Do you have a sponsor: Client sponsor

Primary Addiction: Client substances of choice

List substances you have used in the past and date of last use: Paragraph

How many previous recovery attempts have you had: Text field

What is the longest you have gone substance free: Text field

Are you on any maintenance programs, and if so, which? Text field

Have you lived in a recovery residence before? Text field

MEDICAL INFORMATION: 

Do you have any diagnoses: Client diagnosis

Do you have any allergies? Client allergies

Do you have any other recognized addictions or disorders, such as an eating disorder or self-harm? Client health problems

Have you ever had thoughts of suicide, made any suicide attempts, or received in-patient care for self-harm? Client health problems

List of medications: Medication

List any other relevant medical notes: Client medical notes

Legal Information: 

Do you have any pending legal matters, and if so, describe: Criminal History

List any criminal history: Criminal History

Parole or Probation Officer: Probation

Anything you'd like us to know about this legal information: Paragraph

Getting to Know You: 

What are your hobbies/interests: Paragraph

What are your best characteristics: Paragraph

What are your main goals at this time: Paragraph

Who are your main supports? Contact

Is there anything else you'd like us to know? Paragraph

Please read the following statements and initial to indicate your understanding and agreement:

The Phoenix Recovery Home program requires a 1 year commitment. Initials Text field

The Phoenix Recovery Home program requires a $250.00 non refundable administrative entry fee.  Initials Text field

Program Fee is $100.00 weekly for individuals and $120 weekly for women and children. Each week begins on Monday and ends on Sunday. Initials Text field

 

I agree to take random drug screens for drug and alcohol use that will be administered by staff upon request. Initials Text field

I agree to put any and all romatic relationships on hold at least my first six months of residency. Initials Text field

I understand that the Phoenix Recovery House program I am applying to requires complete abstinence from drugs and alcohol. Any use of drugs or alcohol is strictly prohibited and will result in immediate eviction from the residence. Additionally, disruptive or discourteous behavior within our residence or the community will not be tolerated and may also lead to eviction. Furthermore, failure to maintain employment and pay the program fee on time may result in eviction from the residence. Initials Text field

I have thoroughly read all the materials in this application and have answered each question truthfully. I am genuinely committed to living a sober life and achieving a comfortable recovery from alcoholism and/or drug addiction without relapse. All questions I had have been answered to my satisfaction. Initials Text field

Signature