Sober Apply — BrightSpot Community Housing

Sober Living Pre-Application

Fields marked * are required.

Personal Information

First Name *

Last Name *

Email *

Phone *

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Date of Birth

Home Address

Address Line 1 *

Address Line 2

City *

State *

ZIP Code *

Current Situation

Current Location *

If this is a Treatment Center, Halfway House, Jail, or other Institution, how long at this location?

Discharge Date or Anticipated Discharge Date

Recovery History

What is your Drug of Choice? *

Do you have ANY other addictions, dependencies, or disorders?

What is your longest period of continuous sobriety? *

When (What Year(s))? *

Do you have any mental diagnosis? If so, please explain.

Employment

Employer

Position

Work Phone

Legal History

Are you currently on Probation or Parole? *

Yes No

If YES, where?

What is your PO's name and contact information?

Are you required to register as a sex offender? *

Yes No

If "Yes", where and when was your adjudication date?

Do you have any felonies? *

Yes No

If so, list them below with conviction date and time in days, months, or years that you were incarcerated, if any:

About You

In a sentence or two, tell us why you want to join BrightSpot and why you believe you would be a good fit for our Sober Living Home. *

By submitting you agree to our Privacy Policy. A staff member will contact you within 48 hours.

Sober Living Application

Sober Living Pre-Application