Somerset Sober Living Application
After submitting this application you will be contacted no later than the next business day
Sign in to Google to save your progress. Learn more
Best Phone Number to Contact you
Date of Birth
Describe Your Current Living Situation
Drug of Choice and last used when?
How many years have you been using alcohol and/or drugs?
Do you have any physical health/medical conditions or disabilities.  Please list.
Are you currently using any prescription medication?  Please list.
Do you have any previous felonies or misdemeanors?  Please also list any ongoing legal issues.
Are you able to be employed for at least 31 hours weekly, make recovery meetings, and participate in household chores?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy