Date:
Client Contact Information
Name
Home Address:
City:
State:
Zip:
Primary Phone:
Home Phone:
Work Phone:
Email Address:
Please indicate the best way and time to contact you
DOB:
Current Location
If this is a Treatment Center, Halfway House, Jail, or other Institution, how long at this location?
Discharge Date or anticipated Discharge Date
What is your Drug of Choice?
Do you have ANY other addictions/dependencies/disorders?
Place of employment:
Employer:
Position:
Work Phone:
How did you hear about Trinity Sober Living?
Other
Are you currently on Probation or Parole?
If YES, where?
What is your PO's name and contact information?
Are you required to register as a sex offender?
If "Yes", where and when was your adjudication date?
Do you have any felonies?
If so, list them below with conviction date and time in days, months, or years that you were incarcerated, if any:
What is your longest period of continuous sobriety?
When (What Year(s))?
In a sentence or two, tell us why you want to join Trinity House and why you believe you would be a good fit for our Sober Living Home.
Trinity Sober Living Homes ranges in cost from $400/week - $700/week at the Men's Home in Bensenville. This cost does not include food. ALL fees must be paid four weeks in advance for the next four weeks in order to remain a resident in good standing.
Thank you for considering Trinity Sober Living as a part of your journey toward long term sobriety and an important step toward extraordinary recovery. A member of our staff will be in touch with you within the next 48 hours to discuss the next step toward becoming a resident in our Sober Living Home.