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Supportive Housing Application / Questionnaire

Date of Birth
Do you have a valid Checking Account?
Date available to move in
Have you lived in a Recovery House before?
Are you currently on
Are you current on your Fines / Costs / Child Support?
Are you currently required, or have ever been required to register for Megan's law?
Due to our zoning, vehicles are not permitted. Do you agree not to have a vehicle while living at this residence?
Have you ever received or applied for the CABHC Recovery House Scholarship?
Date

Failure to answer truthfully will result in your immidiate discharge from the house.

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