REQUEST FORM

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REQUEST FORM

REPEAT RESIDENTS ARE SUBJECT TO A 6 MONTH PROBATION AND ADD’L 3 MONTHS FOR OTHER REQUESTS. THOSE WHO ARE FOUND TO BE DATING DURING THAT PERIOD WILL BE EVICTED. YOU MUST HAVE AN APPROVED JOB AT ONE OF OUR PARTNER BUSINESSES. VEHICLES REQUIRE 30 DAY “LIMITED USE” PERIOD, WEEKLY DRIVING COMMITMENT AND YOU MAY NOT TRANSPORT GUYS ON PROBATION WITHOUT *** STAFF APPROVAL. YOU MAY NEVER DRIVE PH2 RESIDENTS FOR “SOCIAL,” OR NON-APPROVED PURPOSES.

Email *

Type of Request: *

Probation Release (NO PHONES OR WIFI DEVICES AT WORK, MEETINGS OR 1198)

Vehicle Purchase (3 months into PH3)

Change Job (minimum 9 months residency, 2 months of phase 3 with BHR partner employer)

Change Sponsor

Other:

Name Of Resident: *

Date of Admission (repeat residents are subject to special requirements) *

YYYY

Who is your current sponsor and your house location ?

Are you in a dating relationship which is a violation of phase 2 guidelines ? *

Yes I am romantically involved

No I am following guidelines

Do you agree as a condition of probation release to attend Saturday evening NA/Eugene Group? *

Yes I Agree to Attend if Not Working

No I Am Unclear About this Requirement

Where are you currently employed? *

Identify your home group: *

ANY PRIVATE CONTACT WITH FEMALES ON THE JOB OR AT MEETINGS WILL RESULT IN EVICTION. You are ineligible for probation release if you are found to be romantically involved other than marriage during residency. Agree? *

Yes

Required

A copy of your responses will be emailed to the address you provided.

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