Recovery Housing Contact List Form
Recovery Housing Collaboration Partners and Stakeholders
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Email *
Name of Your Business/Organization *
How many total homes/residences do you operate? *
Recovery Residences *
Please list ALL and include either the house name or address
City(ies) and County(ies) *
Please list city and county where you operate homes if you did not include an addresses in the list above
Primary Telephone Contact *
Number of Male Beds *
Number of Female Beds *
Website
Average cost per bed *
% of Fund Sources by Category
Please check all that apply
10%
20%
30%
40%
50%
60%
70%
80%
90%
All
None
Contract
Voucher
Resident Rent
Grants
Donation
Medicaid
Referral Sources
Please check all that apply
Community partners that deliver services to residents
Please check all that apply
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