Tell us where you are.
We’ll meet you there.

This single application helps our team understand your needs, determine fit, and prepare for a confidential conversation about availability.

Approximately 8–12 minutesRequired fields marked *Submission does not guarantee admission

About you

Start with the best way for our admissions team to reach you.

First nameLast nameEmailCell phoneDate of birthDesired move-in dateHeightWeight (lbs)Preferred locationBest time to call

Current situation

Help us understand the practical support you may need during your transition.

Marital statusEmployment statusEmployer or School nameDo you plan to bring a car to the house?Do you have a valid driver’s license?Are you currently in an Inpatient Rehab Setting?

Recovery

There is no perfect answer—honesty helps us determine whether the home is the right fit.

Sober date or length of sober timeWhat is the longest period of continuous sobriety you have achieved?12-step fellowship experienceAre you willing to attend meetings, find a sponsor, work the steps, and find a home group?Have you lived in sober living before?What are you hoping to achieve during your time at Integrity Homes?

Health and safety

This information helps us evaluate whether our residential setting can safely support your needs.

Current medications and dosagesMental health diagnoses or current support needsFood or medication allergiesOther medical conditions we should be aware ofAre you currently on probation or parole?Have you ever been convicted of a violent crime?Have you ever been convicted of a sex-related crime?Have you ever been convicted of arson?Have you ever experienced an overdose?Have you ever had a heart attack or stroke?

Emergency contact and agreements

Review the house expectations and confirm that the information you provided is accurate.

Emergency contact nameEmergency contact phoneRelationship to youI understand that rent is due according to the resident agreement and the first payment is due upon admission.I agree to weekly drug testing provided by Integrity Homes.I understand that a positive drug test may result in removal from the home under the resident agreement if I refuse treatment.I certify that the information in this application is accurate and complete to the best of my knowledge.I consent to Integrity Homes contacting me about this application by phone, text, or email.

Ready to submit?

Review your answers before sending. Do not use this form for an emergency—call 911.