New Participant Questionnaire

Your Name (required)

Your Email (required)

Phone Number (required)

Our mission is to remove barriers to re-entry for felons, such as housing, transportation and employment. In order to live in one of our homes, you must be a felon or currently being tried for a felony. Are you now, or have you ever been, on probation or parole or are you currently fighting a case?
---YesNo

Type of Supervision
---ProbationParoleCurrently Fighting Case

Current level of supervision? (if applicable)
---Standard ProbationIntensive ProbationParolePre-Trial Services

Where are you currently living and why do you need to move?

Another aspect of our mission is to provide a safe, structured environment for men to continue in their recovery from alcohol and substance use. Use of alcohol, medical marijuana, illicit street drugs or pills is not permitted. If you live in one of our houses, you must be willing to demonstrate regular effort to improve your recovery and protect the sobriety and wellness of every man in the house. All participants are REQUIRED to attend 3 meetings per week, have a sponsor and either be working the steps or taking another man through them.

Please describe your drug history.

Please describe your legal troubles caused by drug use.

Do you currently attend 12 step recovery meetings?
---YesNo

If Yes, where?

If accepted into one of our homes, do you agree to attend at least three 12 step meetings per week?
---YesNo

Do you currently have a sponsor?
---YesNo

If Yes, what is your sponsor's name?

If Yes, what is your sponsor's phone number?

If you do not have a sponsor, do you agree to get one within one week of moving in?
---YesNo

We believe it is critical for men recovering from substance use and incarceration to be productive and cover their own expenses. Are you currently employed?
---YesNo

If employed, where?

Do you have a valid Driver's License?
---YesNoSuspendedRevokedNever Had One

What is your primary mode of transportation?
---Own CarWalkBikeBus/Light Rail

Thank you for providing all of this information about yourself. We feel it is important to make sure that not only you are a good fit for our program, but also that we are a good fit for you and this part of your journey. There are requirements to live in our homes that some people feel are unnecessary for them. Perhaps not everyone needs to make their bed in the morning, put away their clothes, do their laundry and go to meetings to be successful. To those people, we wish them the best wherever it is that they choose to live. Our houses are intended to assist you in moving forward in life in a meaningful and productive way. Taking personal responsibility for your living area and the common areas of the house is part of this process. Attending meetings and working your personal development through the steps is another part of this process. If you feel you can benefit from the environment we are seeking to provide, please press Send below. We will contact you directly to set up a time to meet and view any available properties.

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