THIS FORM IS MOST EASILY NAVIGATED BY ROTATING YOUR CELL PHONE TO THE SIDE.


RESIDENT APPLICATION, RIVER SOBER LIVING LLC (“River”)

River Sober Living provides men-only homes for gentlemen in recovery who are 18 years and older that do not have multiple convictions of violence, theft, crimes against others in general, ANY sexual offenses, or gang affiliation. 

Upon receiving an application, River will contact the applicant via a phone call to pre-qualify them and set up a time for the applicant and River to express their expectations at the prospective River House with either the Live-In House Manager and/or the Housing Operations Manager.  Over-the-phone expectation interviews can be conducted if the applicant's circumstances require it.  You meet us, and we meet you. 

Today's Date  

First Name Last Name  Middle Name 

(FIRST, LAST, MIDDLE ALL REQUIRED)

State Identification or Driver's License # State of Issue: 

Date of Birth:

Phone:  Email:  
(River needs at least one of these in order to contact you.)

Where do you currently live?

 , , 

In what Cities and States have you lived in during the last 10 years?

Emergency Contact (We will never use your emergency contact information regarding anything other than a true emergency. River does not involve itself in your personal life beyond the house.)

Name: Phone:

Email: Relationship To You:

Are you CURRENTLY on parole? 

Are you CURRENTLY in veteran’s court or drug court? 

Are you CURRENTLY on felony probation? 

Are you CURRENTLY on supervised misdemeanor probation? 

Are you CURRENTLY on pre-trial release?

Are you CURRENTLY incarcerated?

If so, where?

If yes to ANY ABOVE please list the offense(s) and date(s): 

If yes to ANY ABOVE, you are required to provide your Probation/Parole/Pre-Trial Officer/Case Manager's
Name:   Phone:   Email: 

Will you sign a release of information for River Sober Living? 
(*If you wish to be a resident, this may need to be done if your P&P, Pre-trial officer, or case manager requires that you do so in order to communicate with River Management about your record and supervision level.)

Are you willing to submit to a background check? 
(*Every Applicant must be background checked prior to signing a Residency Agreement.)

HAVE YOU EVER BEEN CONVICTED of a sexual crime or arson? 

HAVE YOU EVER BEEN CONVICTED of robbery, burglary, battery, or ANY violent crimes? 
(*ADMISSION OF OFFENSES WILL NOT NECESSARILY DISQUALIFY YOU FROM BECOMING A RESIDENT, BUT MISREPRESENTATION WILL RESULT IN IMMEDIATE DENIAL OF APPLICATION.)

If yes, please explain and include date(s):

Do you suffer from addiction and/or alcoholism? 

What is your drug(s) of choice?

What is your sobriety date? (You are not disqualified if you are not currently sober, but you must enter the house sober.)

Are you self-motivated to sustain sobriety through personal growth? 

Are you currently in an Inpatient Treatment or Outpatient Treatment Program? 

Where?     City, State: , 

Phone:      Counselor’s Name:

If applicable, what is your Patient Identification Number?
(*River may need this information to contact you over the phone.)

What is your discharge date? 

Have you ever lived at River or any other Sober Living House? 

If yes, please include the name and location:

Are you self-sufficient and can you effectively communicate with others? 
(*River Sober Living has no clinical staff nor clinical training.)

Are you suicidal, contemplating suicide, or have you attempted suicide in the past? 

Have you been diagnosed with mental health disorders beyond alcoholism and/or addiction? 
(*Declaring disorders will not immediately disqualify you from being a Resident.  River needs to ensure that we have the support you may need.)

If yes, please list your mental health diagnosis:

Are you currently taking ANY medications? i.e., medication-assisted treatment for opioid addiction (MAT), insulin, pain medications, Adderall, psychotherapeutic drugs, etc. 

If yes, please list the medications and reason for prescription:

AN APPLICANT IS DISQUALIFIED TO LIVE AT A RIVER HOUSE IF THEY PLAN ON TAKING, OR CONTINUE TO TAKE THESE MEDICATIONS UPON ENTRY:
BENZODIAZEPINES, MUSCLE RELAXERS (skeletal muscle relaxers are acceptable), OPIOIDS, AND METHADONE. SUBOXONE, VIVITROL, ETC. ARE ACCEPTABLE FORMS OF MEDICATION-ASSISTED TREATMENT FOR OPIOID ADDICTION UNDER A STRICTLY MONITORED POLICY.

ALL PSYCHOTHERAPEUTIC DRUGS THAT CAN NOT BE USED AS A NARCOTIC ARE ACCEPTABLE, BUT RIVER MANAGEMENT DOES NOT HOLD, DISTRIBUTE, ADVISE, OR CONSULT FOR THE USE OF ANY RIVER-PERMITTED PRESCRIPTIONS.
 

River is a zero-tolerance sober living house.  If relapse occurs, the Residency Agreement will be terminated and the individual must leave the River House under the direction of River Management, which could be to leave immediately. In this case, River will try to help ensure the individual has a place to go. The individual is welcomed and encouraged to reapply after a 30-day period. This is NOT an imposed penalty. In the Founder's experience of living in over (10) sober living houses and now operating them, it is the only way to keep a house a legitimately sober and safe environment and not a house where people don't use or drink that much but continue to live there. It is what is best for our River Houses and the rest of the individuals living there.

In case of relapse and your Residency Agreement is terminated, do you have any plans in place?

If yes, what are they? 

In case of relapse, should River notify anyone?

If yes, who?

Name: Phone: 

Email: Relationship To You:

Do you have a vehicle that will be parked at or near the River House? 

How do you plan to pay the residency fee of $695 every 30 days?

River accepts BPA's SUDS Housing Assistance Program funding, but NOT BPA's Safe and Sober Housing funding.

Are you currently receiving SSI/SSDI?

Are you currently employed? 

If yes, what do you do for work?

If not, do you intend to search for work soon, or once your treatment schedule allows you to have the time to?

How did you hear about River Sober Living?

Do you have any questions or concerns that need to be addressed in a conversation upon River contacting you to pre-qualify you for future residency?

What date would you like to move into River Sober Living? 

New Applicant Signature: