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Potential Qualifying Sober Living Facility
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Name of Sober Living House

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Name of Owner(s) *
Owner(s) email address & phone number *
Business address *
If you are in recovery, how much time of sobriety do you have? *

What is the rent per month of the sober living home?

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Will you accept our payment policy? (Our policy requires that any deposits that a sober living house would normally charge, are waived.  Also, we pay the invoice after the awarded funding has been used, at $19 per day.)

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Are you MARR certified? *

How many structures do you have? 

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Please list the number of bedrooms for each structure.

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Please list the number of bathrooms for each structure. *
How many people can reside in each house?
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Do you have fire extinguishers on every level of the house? *
Do you have smoke detectors on every level in the house? *
Required
If you house people in the basement, does it have an egress window? *
Required
Select which gender your house(s) accommodate.  You can select more than one gender. *
Required

Are any houses handicap accessible?

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Do you have Narcan on-site? 

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What are your meeting requirements? 

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Are you open to multiple pathways to recovery? (i.e. Smart Recovery, Refuge Recovery, Celebrate Recovery, etc.)

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Are there mandatory house meetings?

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Do you support and allow MAT?  If so, check which ones.

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Required

Are medications locked up? 

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What is the curfew?

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Are overnights allowed?

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Are people of the opposite gender allowed in the homes for visitation?
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Please check any box that you assist the residents with:

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Required

Do you have house managers for each location:

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How much time of sobriety does each house manager have? *

Are you funded by the county/state/or Medicaid? 

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Required

Do you drug test the resident upon entry into the sober living home?  If not, why?

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Please check which frequency you drug test.

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Required
What drugs do you test for? Please check all that apply:

If a resident fails a urinary drug screen will you always and immediately show the results to that person?

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What is the protocol if someone relapses? 

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Do you check the resident’s belongings upon entrance into the home for drugs or weapons?

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Required

Please enter the address (street, city, & zip code) of all location(s) and indicate whether each house is male or female.

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Please enter the phone number someone would call to see if there is an opening.

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Please enter the name and phone number of the person FAN would call with any questions. *
Please enter the email address of the person we would notify when someone is approved for the scholarship. *
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