Resident Application-
To be accepted into Hope Recovery housing, this application and a phone interview process must be completed. Carefully read this application and answer all questions that apply to you to the best of your ability. This information is and will remain confidential and be available only to the management of Hope Recovery LLC.
Our requirements are simple! Don’t use, be respectful, and get involved in recovery! We want you to learn to live a healthy life in recovery and move to the next step in your life!
I consent to be contacted by Hope Recovery LLC via SMS, email, or phone using the information I provided for the purposes of reviewing my application.
Radio buttons
Which location are you applying for? Dropdown
Personal Information-
Anticipated move in date:Date
Where are you moving from: Text fieldClient pronoun
Full name: Client first nameClient last name
Preferred name: Client first name
Date of birth:Client birthdate
Contact info: Client phone Client email
Client Address Client City Client State Client Zip
Emergency Contact:
Contact #1
First name: Text field
Last name: Text field
Phone: Text field
Second contact:
First name: Text field
Last name: Text field
Phone: Text field
Do you have a vehicle: Checkboxes
Auto Make, Model and License Plate Number: Text field
Driver’s License Number and State: Text field
Do you smoke tobacco/ vape? Checkboxes
Do you have and plan to utilize a medical cannabis card? Text field
If yes, Hope Recovery only permits odorless forms of medical cannabis, including edibles, lozenges, pill form, or approved vape products.
Residents must provide proof of a valid medical cannabis card and proof of purchase from a licensed dispensary.
Initials acknowledging the medical cannabis policy: Initials Text field
Are you willing to follow all house policies and expectations? Checkboxes
Are you currently homeless or at risk of losing housing? Checkboxes
Are you willing to follow a curfew? Checkboxes
Are you willing to attend required meetings? Checkboxes
Are you willing to live in a shared room? Checkboxes
Do you have any immediate needs such as clothing or toiletries? Checkboxes
Do you need assistance with any self-help, support group and/or networks within the local community? Checkboxes
Do you need help to renew any forms of identification? Checkboxes
Do you need assistance with any food programs? Checkboxes
Criminal history-
Do you have a criminal history of violence or sexual crimes? Checkboxes
Applicants with certain violent or predatory offenses may not be eligible for admission due to safety considerations.
What were your most recent charges: Text field
Do you have Criminal Justice involvement? Checkboxes(If Yes, provide name of P/O, Number, county) Paragraph
Do you have any upcoming court date? Checkboxes If yes, what county and date: Text field date: Date
Recovery Information-
What is the last treatment you attended? Text field/ Did you complete the program? Text field
Have you lived in sober housing before? Text field / If yes, please list the last one you resided in: Text field When did you graduate? Client discharge date
Have you ever been discharged from housing, treatment, or a program due to violence, threats, or rule violations? Checkboxes
Have you experienced an over dose in the past? Checkboxes
If yes:
Date of most recent overdose (if known): Text field
How many overdoses have you experienced? Text field
Were you hospitalized for an overdose? Checkboxes
Are you currently under the influence of alcohol or illicit substances? Checkboxes
Are you willing to submit to a drug screening prior to move-in? Checkboxes
Substance of choice:
Client substances of choice
Client substances of choice
Client substances of choice
What is your last date of use? Date
What is your longest period of sobriety? Text field
Do you have a sponsor/ mentor: Checkboxes
Do you have a CPRS/ Recovery Coach: Checkboxes
If no, are you interested in working with one? Checkboxes
Medications and health conditions-
Are you currently prescribed medications: Checkboxes
Medications: Medication
Are you participating in or about to enter any drug replacement program?
Checkboxes
If yes, what are they: Text field
Medical concerns:
Client health problems
Allergies that we need to be aware of?
Text field
Are you currently under the care of any of the following provider types:
Dropdown Text field
Employment Information:
How do you plan to pay housing fees?
Dropdown Text field
Are you currently employed (Y/N) Checkboxes, If no are you planning to find employment Text field
Employer’s Name/ address/ Phone number/ Scheduled hours working:
Paragraph
Submission of this application does not guarantee admission to Hope Recovery housing. Applications are reviewed based on program fit, safety considerations, and availability.
I certify that the information provided in this application is accurate and truthful to the best of my knowledge.
I understand that providing false information may result in denial of admission.
Signature Date
(Policy Version: 1.0 Effective Date: 3/1/2026)