Sober - Living Application Name * First Name Last Name Date of Birth * MM DD YYYY Phone * (###) ### #### Email * Driver's License/State ID Number State Issued Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Marital Status Requested Move-in Date MM DD YYYY Sobriety Date MM DD YYYY Emergency Contact First Name Last Name Relation Phone (###) ### #### How did you hear about Step Seven? Are you on probation/parole? Yes No If so, where? Officer First Name Last Name Are you on any medication? Including any MAT's? (Medically Assisted Treatment) Yes No If so, what? Vehicle Describe your substance use issues: Please describe your Christian experience: Please describe your ideal living environment: Are you required to register as a sex offender? Yes No Please indicate 'Yes' or 'No' to each of the following statements: My life has become a prison Yes No It might be the sin in my life that has caused this lack of freedom Yes No I can CONSIDER Jesus Christ as my "Higher Power" Yes No Please check 'Yes' or 'No' to each of the following to acknowledge that you have read and understand the statement Our homes are able to operate because each Resident pays their share of the rent and utilities Yes No Each Resident is expected to pay their rent promptly and on time Yes No Each Resident must supply their own food Yes No Step Seven Ministries sober-living homes are completely sober with a zero-tolerance policy Yes No Any drug or alcohol use is grounds for immediate dismissal from the home Yes No All prescription drug use must be approved by Step Seven Ministries Senior Leadership. Failure to notify may result in immediate dismissal from the home Yes No Attendance at your weekly local house meeting is mandatory throughout your stay at Step Seven. Attendance/participation at the Step Seven Ministries groups and church services in mandatory for the first 90 days, and highly recommended thereafter Yes No Each Resident must follow the rules set forth within the Step Seven House Manual Yes No By signing this application, you declare that all of your responses are true and complete and authorize Step Seven Ministries or its authorized agent to verify this information and perform a criminal background check. Any false statement on this application can lead to rejection of your application or immediate removal from the home. This IS NOT A LEASE and you understand that if accepted, this arrangement may be terminated by either party at any time if you fail to adhere to the rules set forth within the Step Seven Ministires House Manual. A criminal record does not immediately disqualify you from participating in our program and each applicant is reviewed on a case by case basis. Signature Print Name Today's Date MM DD YYYY Thank you for submitting your application! We will contact you once your application has been reviewed!
