Apply - Straight Street Sober Living

Step 1 of 5

Personal Information

Tell us a bit about yourself. All information is kept strictly confidential.

First Name *

First name is required.

Last Name *

Last name is required.

Email Address

Please enter a valid email address.

Phone Number *

Phone number is required.

Date of Birth

Gender

Current Situation

Help us understand where you are right now so we can best support your transition.

Current Living Situation

City

State

Employment Status

Employer Name

Recovery Information

This information helps us match you with the right level of support. Be as open as you're comfortable with.

Sobriety Date

What substances have you used?

Describe any previous treatment programs

Currently in Treatment?

Yes

Treatment Facility Name

Legal & Housing

We ask these questions to ensure the safety and well-being of all residents. Honesty is essential.

Pending Legal Issues

On Probation or Parole?

Yes

Probation Officer Name

Probation Officer Phone

History of Sex Offenses? *

Yes

This disclosure is required.

Preferred House

Desired Move-In Date

References & Final Details

Almost there. Please provide an emergency contact and a few final details.

Emergency Contact Name

Emergency Contact Phone

Relationship to Emergency Contact

How Did You Hear About Us?

Why Are You Seeking Sober Living? *

Please tell us why you are seeking sober living.

Additional Information

I certify that the information provided is true and accurate to the best of my knowledge.

You must certify that the information is true and accurate.

Application received.

Thank you for taking this step. We review every application carefully and will be in touch within 2-3 business days to discuss next steps.