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Resident Application Form

Please fill out all required information below.

First name*

Last name*

Email address*

Phone number

Current Address*

Desired Move In Date*

Month

Day

Year

Birthday

Month

Day

Year

Sobriety Date

Month

Day

Year

Are you currently in treatment? If yes, what is you treatment?

List any previous sober living experience and how long you stayed at ach location.

Are you currently on probation/parole/court supervision?

Check all Referral Source That Applies

Treatment Center

Court

Family/Friend

Therapist

Nonprofit Organization

Other

Use the space below to answer these questions on recovery participation. 1. Current recovery meetings or programs attended 2. Sponsor or recovery mentor? 3. What does recovery support look like for you?

Why are you seeking recovery housing at this time?

What are your personal goals during residency?

What does a supportive environment mean to you?

What strengths do you bring to a shared living environment?

Have you ever been convicted of a violent offense? *

Are you currently required to register as a sex offender? *

Have you ever been discharged from a sober living program?*

Do you agree to follow house expectations and sobriety requirements? *

Are you willing to participate in community living responsibilities?*

Check boxes below before submitting application. *

I understand this is a recovery focused environment

I agree to maintain sobriety while residing in the home

I understand residency is contingent upon following house expectations

I authorize verification of information provided

I understand submission does not guarantee acceptance

By Typing Your Name You Agree to Submit this Application. *

Desired Location*

Waverly Place (Women Only)

Diane's House (Women Only)

Ember House (Men Only)

Other

One More Light Residences

Address:

3520 Snouffer Rd, Suite 100

Email:

info@omlresidences.com

Phone:

380-224-6958

Opening Hours

Mon - Fri

9:00 am – 5:00 pm

Saturday

9:00 am – 2:00 pm

Sunday

9:00 am – 2:00 pm

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