Men's Application and Sober Housing Agreement for Stronger Sober House

Men's Application and Sober Housing Agreement

 

First Name Client first name Middle InitialClient middle name Last Name Client last name

Nickname:  Client nickname

Deposit:  $150 |  Program Fee:  $700/mo  or $850/mo (single room)
Note:  $25 daily rate, Fee/balance after applying any housing credit is due upfront
ACH:  Rtg# 291075116 Acct# 101000000849468 | Cashapp $strongersoberhouse | Venmo @strongersoberhouse  |  Paypal @strongersober | Square

Desired Move-in Date: Date  Birthdate: Client birthdate  

Email:  Client email SSN: SSN Phone: Client phone

Are you on Probation or Parole or are pending? Dropdown

What is your Mental Health Diagnosis, if any? Text field

Drug of Choice:  Client substances of choice

Outpatient Program: Text field  Date of Intake: Date  Amount of Housing Stipend:  Text field

Are you on Probation or Parole or are pending? Dropdown

Are you a Sex Offender? Dropdown

What is your Mental Health Diagnosis, if any? Text field

Faciltiy Location Preference:Client facility

Any thing else we need to know about you or your application?  Client notes

Sober Date: RecoveryHistory (Relapse Date optional)

Check All Applicable:

Checkboxes

Have you experienced Homelessness in the last 10 years: 

Radio buttons

Referred by:  Text field

Gender:Client gender

Race:Client race

Ethnicity:  Client ethnicity

Marital Status:Client marital status

Veteran:Client veteran status

Prescribed Medication(s): Everything is optional except name Medication 

Emergency Contact:  Contact

Emergency Contact (phone):  Text field

Emergency Plan:  Text field

Employer:  Text field 

How Long?  Text field

Sponsor:  Client sponsor 

Home Meeting: (location/day/time)  Text field

If application is accepted, I assume the obligations of residency and agree to the following conditions:

  1. Any use of alcohol or drugs will result in immediately being asked to leave and loss of sober deposit.
  2. Any destruction of property will result in prosecution and immediately being asked to leave.
  3. Failure to follow house rules and expectations may result in being asked to leave.
  4. Program fee is due the 1st of each month; failure to pay Program fee by the 5th of the month will result in a $35 late fee and may result in immediately being asked to leave.
  5. A sober /damage deposit will be required before residency begins.
  6. Sober/damage deposit will be returned within 30 days of vacancy if entitled.  If your deposit is paid by a deposit assistance program, you will not be entitled to any deposit refund.
  7. At least a 30-day notice is required from house member to end Housing Agreement (as long as you have completed or will have completed the 4-month commitment)
  8. Any false information can result in immediately being asked to leave. 

By signing below, I am giving a release to speak with my probation officer and/or emergency contact. 

If I drink/use or leave before my 4-month commitment is up or am asked to leave for not following house rules and expectations, I will lose my deposit and program fee for that month.  No Refunds.  Initials: Initials Text field

This is a Housing Agreement, not a Lease: By signing this agreement, you understand that residency in this sober home is contingent upon adherence to the house rules and participation in the program. This agreement is not a rental lease, and rental rights do not apply. As such, residents may be asked to leave the premises if they fail to comply with the rules or the expectations of the sober living environment. Initials Initials Text field

 Signature: Signature 

Date:  Date

House Expectations

Sobriety

  • You are expected to maintain a healthy and sober lifestyle
  • Attend 2 12-step meetings a week
  • Regularly communicate with your sponsor
  • If you do not currently have a sponsor, the expectation is to have one in 60 days

Personal

  • Personal living area is neat – beds made, floors picked up, at a minimum
  • Clean up after yourself in common areas
  • Excessive profanity is not allowed
  • House jobs will be completed daily
  • Smoking (including e-cigarettes) is not allowed in any area of the house. Smoking is only allowed in the rear of the house.  InitialsInitials Text field

Time

  • Curfew is 11pm Sunday/Monday/Tuesday/Wednesday/Thursday and 12am Friday/Saturday
  • Each house member is expected to spend 30 hours total:  working, looking for work, doing service work, going to school, or attending outpatient treatment
  • Retired and Disabled expectation is 15 hours/week

House Meeting

  • Each house member is expected to participate in the weekly house meeting to discuss:
    • Your week
    • Any issues you may have with other house members
    • Conditions of the house

Overnight Away from the House

  • Approved 24 hours in advance by House Manager
  • Request includes where and when you will return
  • Overnight pass allowed after 30 days and weekend passes allowed after 60 days.

Guests

  • Overnight guests not permitted
  • Guests permitted in common areas only  Initials Initials Text field

Car

  • You must have a Driver’s License
  • One car allowed and must have current tabs, proof of insurance and be in working order
  • Parking on neighbor’s property or blocking their driveway is not allowed by house members or guests

Food

  • Each house member is expected to properly mark personal food items and dispose of them properly

Storage

  • Bring only what you need and fits in your dresser/closet/under bed/approximately 2-3 bags
  • Excessive items will be decided by House Manager/Owner
  • If you need to store a box or 2, storage starts at $30/month

You can’t bring in anything with alcohol or drugs in it. The rights of all house members to a safe, clean, sober and peaceful environment to support recovery will be maintained.  Failure to meet house expectations will result in a house member being asked to leave within 30 days. Initials Initials Text field

Learning to Live Drug and Alcohol Free

All House Members are expected to maintain a sober lifestyle.

What does that mean?

To live in this sober house means you want help with your sobriety, and you are willing to give help for others’ sobriety.  To do that you need to spend time during the week getting to know the people you live with and letting them get to know you.  So to do that you can’t spend all the time you are in the house in your room.

Or

Leaving the minute, you wake up and returning 2 minutes before curfew.

Or

Returning and going straight to your room.

That is not taking part in a sober house. 

Also, how are you helping others stay sober if they can’t get to know you?

Furthermore, if you can learn this here, you can use it to make connections at meetings and anywhere else in the community.  If we take the time here to learn to talk to each other about ourselves; to learn ways to constructively communicate concerns about other’s behavior; we have a great opportunity to build a solid foundation for our lives. 

Living in a sober house means you want to be held accountable to live a sober lifestyle (keeping your room clean/cleaning up after yourself in the rest of the house – according to House Manager)

To be sober, it is more than not using or drinking, it is a change in lifestyle; you treat yourself better and the people around you.  Being honest and respecting of yourself and others is all part of the changing process. 

Get a sponsor, work the steps, and then help others.

  1. If I drink or use drugs, I will lose my sober deposit and that month’s program fee will not be returned.    Initials Initials Text field
  2. If I do not complete my 4-month commitment I will lose my sober deposit.  Initials Initials Text field
  3. If I do not give a 30-day notice that I am leaving after my 4-month commitment I will lose my sober deposit.  Initials Initials Text field
  4. Any violence or threat of violence will result in immediate termination and loss of sober deposit.  Initials Initials Text field

Print Name:  Text field

Signature:  Signature

Date: Date

Sober Home Resident Bill of Rights

As a resident of this sober home you have rights that the residence staff will safeguard during your stay.  You have a right to:

  1. An environment that supports your recovery.
  2. An environment that is safe and free from alcohol and other illicit drugs or substances.
  3. Be free from physical and verbal abuse, neglect, financial exploitation, and all forms of maltreatment covered under the Vulnerable Adults Act, sections 626.557 to 626.5572
  4. Be notified if the home supports Medication Assisted Treatment (MAT).
  5. Be treated with dignity and respect and to have personal property treated with respect.
  6. Have personal, financial, and medical information kept private and to be advised of the sober home’s policies and procedures regarding disclosure of such information.
  7. Assert these rights personally or have them asserted by the individual’s representative or by anyone on behalf of the individual without retaliation.
  8. Have your spiritual, cultural, and religious beliefs respected.
  9. Be actively involved in setting your recovery goals and length of stay.
  10. All good faith efforts to protect your privacy and anonymity throughout your stay.
  11. Have access, while living in the residence, to other community-based support services as needed.
  12. Be referred to appropriate services upon leaving the residence if necessary.
  13. Retain personal property that does not jeopardize your or others’ safety or health.
  14. Be provided with the name, address, and telephone number of the ombudsman for mental health, substance use disorder, and developmental disabilities and information about the right to file a complaint.
  15. File a complaint to the owner/operator or other oversight organization (e.g., MASH) without fear of retaliation.1
  16. Be fully informed before changes occur in these rights and responsibilities as well as to changes in policies and procedures should they occur.
  17. Not to be required to perform services for the residence, which are not included in the usual expectations for all residents.
  18. Be fully informed of any fees that you may be charged and if a third party pays any fees on your behalf.
  19. Have at least one emergency contact kept on file by the home to reach out to in the case of an emergency, discharge, or death.

I have been informed of my rights as listed above.

Print Name: Text field

Signed: Signature Date: Date

1 To file a complaint, please fill out the Complaint Form found on the MASH Website.

For more information, and any other questions or concerns you may have, please contact us at: Phone: (612) 223-6274   Website: https://mnsoberhomes.org/