Realize U 252 - Sober Living Application
Thank you for your interest in the Realize U 252 Sober Living Program. The application requires that this entire form is completed below and a separate authorization form is signed and submitted. You should have received that authorization with a request for a digital signature. If you can not find the authorization, please send an email to director@realizeu252.org and we will provide it to you.

Before your application is considered, you will have an opportunity to review the Sober Living Resident Guide & Welcome Package which includes all the program rules, policies, and expectations. Please review this information in detail and take the opportunity to ask any questions you have about the information provided.

Download the Sober Living Resident Guide & Welcome Package here: https://drive.google.com/file/d/13gKU6NLYtT1HxNnsb5iSpHGPWk0sY7xT/view?usp=sharing

Once you have completed this form, the authorization, and an initial interview with the program director, you will be required to provide a NON-REFUNDABLE application fee of $350 so we can complete the application and screening process. We cannot refund this application fee for any reason so we highly encourage you to review all the documents and have all your questions answered before submitting the application.

Please complete everything on this form to the best of your ability. Be honest and truthful with your responses. If we discover that any information was misrepresented, this may preclude you from ever participating in a Realize U 252 program. The submitted application will be kept confidential by the organization.

If you cannot complete this form entirely right now, provide the information you can and you can provide the rest at a later date.

Any questions you have at this time can be addressed to director@realizeu252.org.
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Email *
First and Last Name *
Address | City | State | ZIP *
Phone Number *
Mobile Number (if different)
Date of Birth *
MM
/
DD
/
YYYY
Age *
License/ID# and State *
Gender *
Relationship Status *
If not married but in a current active relationship, how long have you been involved?
Children and Dependents: *
Emergency Contact 1 *
Emergency Contact 1 Phone Number *
Emergency Contact 2 *
Emergency Contact 2 Phone Number *
Name of Individual Responsible for Payment (or "self") *
Payer Address | City | State | ZIP
Payer Phone Number
Payer Relationship to Applicant
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