Recovery Residence Housing Application

Recovery Residence Housing Application

Check the box below of the Organization you are applying to:


Thank you for filling out our online application.  Questions with a * must be completed in order to submit the application.  All information is confidential.  If you have not heard from us within 24 hours after submission, please call 612-991-1534 to speak with our Intake Coordinator.  We look forward to welcoming you!

Our office mailing address is P.O. Box 135, Waconia, MN  55387

If mailing your deposit, please send money orders only with your name clearly written and the home you will be moving into.

If the blanks to be completed are yellow or you are unable to submit, the web browser you are using is outdated. Please update web browser or try a different web browser.  The application can be completed with your cell phone. 

General Questions

Today's Date:*  Date

First Name:*  Client first name  Middle Name:  Client middle name  Last Name:*  Client last name

Email:  Client email  Cell Phone Number:  Client phone

Best number to contact you about your application:  Text field

Gender (NSH/ASL is men's-only sober living.  You must identify as male.):  Client gender  Birthdate:*  Text field   Age:  Text field

If You Will Be Bringing A Vehicle To The Home, List Make And Model Here:  Text field

Driver's License Number:  Text field  State DL Was Issued And Expiration Date:  Text field

If you do not have a current driver's license, vehicle insurance, and current license tabs, do not bring your car or motorcycle.

Date You Would Like To Move In:*  Date 

Have You Lived at a New Spirit Homes or American Sober Living Before?  If So, Approximately What Date Did You Move Out?  Text field

Date You Would Like To Schedule A Tour (tours not required):  Date 

Estimated Length of Stay At New Spirit:*  Client estimated length of stay 

Your Sobriety Date (date of last use):*  Text field

If Enrolled in IOP, Where Will You Be Attending:  Text field 

IOP Start Date (list date):  Date

Current Employment:  Text field  Occupation:  Text field

How Will You Be Paying For Your Housing:*  Text field

Criminal History

Have You Been Accused or Convicted Of:   Arson?*  Radio buttons  Sex Crimes?*  Radio buttons

Have You Ever Been Convicted Of Physical Violence?*  Radio buttons

List Details On ALL Arrests, Convictions, Prison/Jail Time, Probation History, Pending Charges, and Probation Officer Infomation:*


Medical History

Diagnosis (Include Mental Health):*  Text field  Substance of Choice (List All):*  Text field

Allergies (food, medication, cats):  Text field  Last Relapse Date:*  Text field

Why Did You Relapse:* Paragraph

How Many Times Have You Been Through Treatment:  Text field

Were you released from another sober house in the past 30 days:  Radio buttons

If yes, please explain circumstances in detail:  Paragraph

Have You Ever Planned or Attempted Suicide In The Last Three Years:*  Radio buttons

Do snore loud enough to keep a roommate from sleeping (we will do our best to put you with other snorers):* Radio buttons

Referred By

How Did You Hear About Us:*  Text field   

Treatment Information

Treatment Center:*  Text field   Counselor Name:*  Text field 

Counselor Phone:  Text field   Counselor Email:  Text field

Emergency Contact Information

Name:  Text field  Phone:  Text field

Relationship:  Text field  Email:  Text field

Sponsor Contact Information 

Name:  Text field  Phone:  Text field

Type:  Text field  Email:  Text field


List all medication you currently take or know you will be taking while living at New Spirit Homes/American Sober Living.

Prescription Medication #1

Medication:  Text field  Dosage:  Text field  Quantity:  Text field  Frequency:  Text field

MD:  Text field  Notes:  Text field

Prescription Medication #2

Medication:  Text field  Dosage:  Text field  Quantity:  Text field  Frequency:  Text field

MD:  Text field  Notes:  Text field

Prescription Medication #3

Medication:  Text field  Dosage:  Text field  Quantity:  Text field  Frequency:  Text field

MD:  Text field  Notes:  Text field

Prescription Medication #4

Medication:  Text field  Dosage:  Text field  Quantity:  Text field  Frequency:  Text field

MD:  Text field  Notes:  Text field

Other Medications List Here:  Text field

Why have you decided to live in a Recovery Residence (Soberhome)?


Do you have any questions for us?


Download a copy of your application as it has our contact information.  By submitting this Application you state that all information provided is true and accurate.  You understand that false information or failing to disclose requested information will result in discharge from the New Spirit Homes Sober Living Program and forfeiture of your sober deposit.  You agree that you have filled out this application with honesty and integrity. Thanks--way to go!

Below is a list of things you will need to bring with you.  If you need us to lend you any of the below items, just let us know IN ADVANCE:

You must make contact with the House Leader to make move-in arrangements. DO NOT SHOW UP WITHOUT A SCHEDULED MOVE-IN DATE AND TIME.  

Bring food with you for the first few days.  Meals are not provided; you prepare your own meals.  Plates, silverware, and pots & pans are all provided for you.

Small lockbox for all medications, including aspirin.  All medications must be in their original prescription bottle, and you must have a current prescription for them.

Personal care products (soap, shampoo, razor, towel, etc.)

U-type lock for your bike, if you are bringing one.  Other types of locks are ineffective.

Clothes for two weeks with hangers There are High-Efficiency FREE washers and dryers at each house.

Only the shoes you wear on a regular basis.

Sheets, mattress cover, and comforter for a twin bed.  Pillow and pillowcase.

A positive attitude and the passion to remain free from drugs and alcohol. 

Do not bring furniture or large items to store such as musical instruments.  There is storage available for your suitcase.