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HSS Recovery House Resident Application
Welcome to HSS Recovery House (Wilmington, DE). Please note: Applying does not guarantee admission. HSS is not a detox, hospital, or inpatient treatment facility. We support residents in their recovery journey.
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1. Applicant Information *
Full Legal Name *
Preferred Name *
Date of Birth *
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Phone Number *
Email Address *
Current Living Situation *
Preferred Contact Method *
Requested Move-in Date *
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Referral Source (if applicable) *
2. Safety and Recovery *
Do you currently need emergency care, medical detox, hospitalization, or inpatient treatment? *
Safety Alert
Date of last substance use *
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Substances involved (if comfortable disclosing) *
Reason for seeking recovery housing *
Current recovery goals *
Current recovery supports (e.g., sponsor, therapy, support groups) *
Are you willing to live in a substance-free residence? *
3. Schedule and Support Needs *
Employment or Education commitments *
Active treatment or court/supervision obligations *
Do you have reliable transportation? *
Do you have access to a smartphone? *
Do you understand that you must use the H.E.L.P. Recovery Mode app? *
Do you need technical help, language assistance, or reasonable accommodation? *
Prescribed medication and MOUD do not automatically disqualify an applicant. Do you take prescribed medication or medication for opioid use disorder? *
Can you self-manage your medication, or do you need secure storage or assistance? *
5. Emergency Contact *
Emergency Contact Name and Relationship *
Emergency Contact Phone and Email *
Do you grant permission to contact this person for emergencies and non-emergencies? *
Required
Do you understand your rent fee? *
Expected payment source *
7. House Rules *
I understand
I need an explanation
I need an accommodation
Curfew is 10:00 p.m. every day.
Visitors must leave by 6:00 p.m.
Visitors may use only the living or dining room and may never go upstairs or into bedrooms.
Overnight guests are prohibited.
Overnight-pass applications begin only after 30 successful days and still require approval.
The residence must remain substance-free.
Residents participate in meetings, chores, recovery activities, screening, and the H.E.L.P. Recovery Mode app.
App alerts or technical problems do not automatically prove relapse or justify termination.
Are there any probation, parole, court restrictions, protective orders, or serious safety concerns affecting placement? *
I certify that all responses are accurate to the best of my knowledge and consent to application-related contact. *
Full Name (Signature) *
Date *
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Final questions or comments for us? *
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