Applying Online.

Before you begin your online application:

Please read the following checklist before submitting an application. The content of your application will only be reviewed by the owners and your documentation will be destroyed if we are not a fit.

You agree to the following:

You will provide consent to the names and locations of where you have been for treatment.
You will provide the date of your sobriety.
You will provide a list of the names and dosages of your current medications.
You will provide your authorization to speak to a list of individuals while in tenancy at Become Sober Home.
You must dedicate yourself to one of the following in your schedule: Volunteering, Attending School or Be Employed.

Please note that submitting an application does not guarantee residency. All applications must be reviewed, and interviews must be conducted prior to acceptance. If you do not hear from us within 7 business days, please contact us to verify that your submission was received.

I have read and agreed to the terms above.

Become Sober Home online application form.

Personal Information

Your Full Name

Your Date of Birth (YYYY-MM-DD)

Your Gender

Address

City

Postal Code

Your Phone Number

Email Address

Emergency Contact Information

Full Name

Relationship

Phone Number

Email Address

Medical Information

Are you currently under the care of a physician or therapist? If yes, please provide details. List any medications you are currently taking:

Notes (Optional)

Addiction and Recovery History

Substance Use History:

Detox History / History of Complicated Detox:

How long have you been in recovery?

Recovery, Past Treatment, Program and Counselling Experience:

Notes

Mental Health Concerns / Stability:

Safety Assessment: Risk of harming self or others?

What motivated you to seek admission into our sober living home?

Your Reason

Employment and Education Information

Current Employment Status

Educational Background

Legal History

Court / Legal System Involvement and Circumstances:

Do you have any pending legal charges or previous convictions? If yes, please provide details:

Notes (Optional)

Additional Comments and Information

Please use this space to share any additional information you believe is important for us to know about you.

Notes (Optional)

Acknowledgment and Consent

Please complete the checkboxes below:

I acknowledge that by submitting this application, I am seeking admission into Become Sober Home and agree to abide by all rules and guidelines set forth by the facility.
I consent to Become Sober Home using the information provided in this application form for the purpose of evaluating my suitability for admission into the sober living home.