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CRH Sober Living
To be accepted in a Comeback Recovery Home sober living residence, completion of the following application is required.
Resident Admissions Application
Resident Admissions Application
Resident Information
Name
*
Name
First
First
Last
Last
Email
*
Phone
Estimated Monthly Income
*
Date of Birth
*
Narcan Trained
Recovery Information
Sobriety Date
*
Drug of Choice
*
Sponsor
*
Yes
No
Not Applicable
Sponsor Name
Sponsor Phone #
Mental Health Issues
*
Medical Issues
*
Emergency Contact Name
*
Emergency Contact Number
*
Sober Living House History
*
On Probation/Parole
*
Yes
No
Probation/Parole Officer Number
*
Food Stamps?
*
Yes
No
Sex Offender
*
Yes
No
Prescription Drugs
*
Yes
No
List of Drugs & dosage
*
Currently employed?
*
Yes
No
Employer
*
Employer Phone #
*
Submit
If you are human, leave this field blank.
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Opening October 2024!
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