Applicant Name:
Client first name
Client last name
Applicant's Date of Birth:
Client birthdate
Applicant's Telephone Number:
Client phone
Applicant's Email Address:
Client email
Applicant's Home Address:
Client Address
Applicant's Requested move in date:
Date
Where are you currently living and/or receiving services?
If you're in treatment or sober living, please provide the name:
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Please provide your sober living history:
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Please provide your treatment history:
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Do you currently have any legal issues?
If so, please describe:
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Do you currently have a valid driver’s license?
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Do you plan to bring a vehicle with you?
Vehicle must be insured.
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Current Medications & Purpose:
List all medications you currently take and what each one is for (e.g. anxiety, sleep, blood pressure, etc.):
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Please list all of your diagnoses:
(Examples: substance use disorders, depression, anxiety, bipolar disorder, eating disorders, etc.)
Client diagnosis
What health insurance do you currently have?
*Note: The McCoy House does not bill insurance; however, insurance is required for IOP and individual therapy services unless the applicant plans to pay out of pocket.
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What allergies do you have?
Client allergies
Please provide an emergency contact.
Emergency Contact Name:
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Emergency contact's relationship to applicant (mother, father, friend, sister, etc.):
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Emergency Contact's Phone Number:
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Emergency Contact's Email Address:
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Emergency Contact's Home Address:
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Next, we'll ask you to fill out and sign two releases of information.
1 - for your current facility, therapist, or case manager
2 - for an additional contact person (family, friend, pastor, your emergency contact, etc.)
Release of Information
Applicant Name: Text field
I hereby authorize the exchange of confidential information between The McCoy House Extended Care for Women and the parties listed below in ALL the following areas including, but not limited to: medication, treatment plans, aftercare plans, discharge summary, psychiatric testing and assessment, emergency contact, and progress reports. Please provide the information below for the person you are granting The McCoy House to contact.
We need a signed release for your current therapist or case manager. If you move in, we will request that you sign a release for your new therapist in IOP/OP.
If you would like to grant us permission to speak with other friends or family members, please reach out to staff to request a new release of information for each individual.
Current Facility or Therapist/Case Manager
Name of Facility (if applicable):
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Name of current therapist or case manager:
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Relationship (i.e., case manager, therapist, etc.):
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Address (city, state):
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Telephone Number:
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Additional Contact
Contact Name:
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Relationship to resident (i.e., family member, friend, emergency contact, pastor, etc.):
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Contact's telephone number:
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Contact's email address:
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Contact's address (city, state):
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Applicant Signature:
Signature
Date:
Date
Please review our house guidelines and financial information.
After you submit your application, you can download and print it out for your records.
House Guidelines
The McCoy House Extended Care for Women is a structured, compassionate recovery housing program dedicated to helping women heal, rebuild, and thrive in recovery. We provide a supportive environment focused on accountability, personal growth, and community connection.
The following guidelines are in place to create an environment that supports your recovery and ensures the safety and well-being of everyone in the home. The McCoy House is more than a place to stay — it is a community built on respect, accountability, and mutual support.
The reputation of The McCoy House Extended Care for Women reflects the strength and integrity of the women who live here. Therefore, if you choose to make The McCoy House your home, you are committing to conduct yourself in a way that upholds that reputation, both inside and outside the house.
These guidelines are not meant to restrict you, but to provide structure, stability, and consistency — the very things that help foster growth and healing. By following them, you contribute to a safe and nurturing space where all residents can thrive and continue their journey of recovery. You will be expected to adhere to these guidelines as part of your commitment to our program. Please read them carefully and reach out to a staff member if you have any questions or need clarification. We are here to support you every step of the way as you continue your journey of recovery.
1. A minimum 90-day commitment is required.
2. No use of alcohol, drugs, or mood-altering substances (this includes the use of laxatives, diuretics, steroids, energy drinks or weight loss products) and these are not permitted on the property. The only exceptions are medications taken under the care of a physician and a release of information must be signed for the treating physician.
3. Residents must submit a list of ALL medications they are taking including over the counter medications.
4. Residents are required to participate in individual therapy, an aftercare program and/or an intensive outpatient program while residing at The McCoy House as well as programming provided by The McCoy House (equine therapy, yoga, art therapy).
5. Each resident must complete a daily schedule everyday accounting for every hour.
6. Each resident must be actively working a Twelve Step Program, attending at least three meetings per week and have and maintain a sponsor within two weeks of moving in.
7. Residents may be required to submit to random drug testing at the discretion of staff and will be responsible for all costs incurred.
8. The use of personal computers and phones will be monitored. The McCoy House will follow recommendations from the resident's outpatient program regarding the use of phone and computer access.
9. No use of pornographic material, erotica, sex toys, computer dating sites, cybersex, chat lines, sexual phone calls, any form of sexual acting out behaviors or inappropriate sexual language or discussions. No viewing of violent or inappropriate sexual movies.
10. Residents must dress appropriately. (No low-cut tops or see-through clothing, shorts, skirts and/or dresses must be of an appropriate length. No seductive or sexually suggestive clothing can be worn). Clothing with logos related to drugs, alcohol, sex, gambling, or inappropriate language is prohibited.
11. Residents must notify staff of any medical, psychiatric, or dental appointments that are scheduled and of all prescriptions written.
12. Residents are prohibited from undergoing any elective surgery, piercings, tattoos or going to tanning beds.
13. Residents are required to volunteer at The Real McCoy Thrift Store at least two shifts per week while residing at The McCoy House.
14. After the first month, residents can apply for a part time job (up to 20 hours/week) but all other house requirements (i.e. thrift store shifts, spirituality, meetings, therapy, IOP, McCoy House Programming) must still be met.
15. Residents may look at options to continue their education while at The McCoy House. Verification of work and/or school schedule is required and other house requirements (i.e. thrift store shifts, spirituality, meetings, therapy, IOP, McCoy House Programming) must still be met.
16. Each resident is required to sign a release of information for their outpatient therapist/agency and one family member or emergency contact.
17. Residents are expected to be positive role models for new residents and assist them through the initial transition to the house.
18. Each resident is responsible for her own personal cleanliness and laundry, as well as the general cleanliness of the facility, particularly own bedroom and bathroom. This includes laundry of sheets and towels.
19. Residents are required to participate in daily and weekly household chores per schedule.
20. Residents are not permitted to light candles in the house.
21. All residents are required to adhere to the house curfew of 10 p.m. daily for the first month. After the first month, the weekend (Friday and Saturday) curfew can be 11:00 p.m. if the resident is following guidelines.
22. Prior authorization is to be obtained for visitors or family members. Visitors, except for sponsors, are not recommended for the first 30 days.
23. After the first 30 days, guest and weekend passes will be approved on an individual basis.
24. No weapons of any kind are to be brought onto the property or into the house.
25. Stealing, physical violence, threats, acting out or use of any type of weapon will result in immediate discharge from The McCoy House and/or legal consequences.
26. Residents are prohibited from going to establishments that are not conducive to recovery, i.e., bars, clubs, casinos etc.
27. Personal items containing alcohol, or any questionable substances are prohibited.
28. Residents are to inform staff if they are ill and unable to adhere to their daily schedule. A resident will have to take a breathalyzer and/or drug test when these instances arise.
29. Smoking is permitted ONLY in the outside designated areas. No smoking or vaping in the house.
30. Establishing new sexual or romantic relationships are prohibited while the client is a resident at The McCoy House.
31. Use of Facebook or any other form of social media is prohibited.
32. Residents are not permitted to travel alone for the first month. They are to be always accompanied by another resident.
33. Automobiles must be licensed, insured, have current tag and registration. The McCoy House does not guarantee transportation for residents. Staff, when available, will assist in providing transportation.
34. Televisions are not allowed in the bedrooms.
35. Cell phones are to be turned to “silent” at curfew. Residents must have permission from roommates to use the phone, computer, or tablet in the bedroom. Cell phones will be confiscated at curfew if residents use them excessively.
36. Residents must respect each other’s boundaries and privacy.
37. Residents are not permitted to go into other residents' rooms without permission.
38. Bedroom doors are NEVER to be locked.
39. Residents may receive mail at The McCoy House. All mail received after the resident has left will be returned to the sender.
40. Residents are strongly discouraged from having contact with peers who have been discharged from The McCoy House for non-compliance.
41. Personal belongings left at the house following the resident's departure will be donated to a local charity. Items will NOT be mailed or stored.
42. Residents can be discharged immediately from the facility for non-compliance and negative attitude.
43. As issues arise, staff may create specific guidelines needed to best support a resident. Any new guidelines will be written into a contract and signed by the resident and staff.
44. Participation with gym memberships and meal-kits are not required but are strongly encouraged.
Please review these guidelines and feel free to contact The McCoy House with any questions you have. You will be asked to acknowledge and sign a copy of the house guidelines on your move in date.
Financial Information
The monthly rent is $1,500.
First payment is due on the day of arrival. Rent is prorated on the move in date and rent is due on the 1st of every month following move-in.
A $500 nonrefundable registration fee is due on or before the day of arrival.
Payments are accepted by check, cash, credit/debit card, or ACH. There is a 4% fee if paying by credit/debit card. There is a 0.5% fee if paying by ACH. If paying by check, please make checks payable to The McCoy House Extended Care for Women. Checks can be mailed to P.O. Box 231, Ridgeland, MS 39158 or dropped off in person. A link to pay via credit/debit card and ACH can be emailed to you if you choose to pay that way. Reach out to staff if you want to pay by debit/credit card or ACH.
There are no refunds on monthly rent if the resident leaves or is discharged.
Residents will receive a 10% discount on monthly rent if they pay for 90 days in advance. This will not be refunded if the resident leaves prior to 90 days or is discharged for any reason.
Scholarships may be available on a case-by-case basis. Please reach out to staff if you have questions about scholarship.
All utilities are included in the monthly rent.
A payment agreement and payment schedule will be provided and must be signed by the resident.
The McCoy House provides the following items:
1. Programming – Equine Therapy, Yoga, Art Classes, Group Outings, Meal Kits (two dinners per week for the house), Gym Memberships
2. Sheets
3. Bedspread
4. Blankets
5. Pillows
6. Mattress covers
7. Towels
8. Toilet Paper
9. Paper Towels
10. Garbage Bags
11. Laundry Detergent
12. Household cleaning supplies
13. Coffee
14. Transportation to and from programming and activities that are required by The McCoy House
*Note: The McCoy House does not provide food or transportation for activities or appointments that are not required as part of McCoy House programming.
All done, please click submit. We will be in touch soon. Thank you!