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Priority Resident Interest List
Tell Us About You
Full Name
*
Phone Number
*
Email Address
*
Date Of Birth
*
Current City & State
Recovery Journey
What best describes your current situation?
*
○ Transitioning from treatment
○ Currently in sober living
○ Living independently
○ Staying with family or friends
○ Other
How long have you been sober?
*
○ Less than 30 days
○ 30–90 days
○ 3–6 months
○ 6–12 months
○ Over 1 year
○ Prefer not to answer
Are you currently working with any of the following?
*
Living Preferences
When are you hoping to move?
*
○ Immediately
○ Within 30 days
○ Within 60 days
○ Just exploring options
Preferred Room Type
*
○ Shared
○ Private (when available)
○ No Preference
Transportation
*
○ I have reliable transportation
○ I use public transportation
○ I will need transportation resources
Employment & Stability
Current Employment Status
*
○ Full-time
○ Part-time
○ Looking for work
○ Student
○ Other
Primary Source of Income
Tell Us More
What are you hoping to gain from your next sober living home?
*
What does a safe space mean to you?
*
Stay Connected
Would you like to receive updates about:
Final Acknowledgements
*
☐ I understand this is an interest form and not a housing agreement.
☐ I understand placement is based upon availability and eligibility.
☐ I certify the information I provided is accurate.
Join the Priority List!
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