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The Vibe Recovery Co-OP
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*Fill out your name, contact info, and any other information you want us know.  The last section on the form is for questions.
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First & Last Name
Date of Birth
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Phone Number
Email
Current Address or Location (note if in treatment or sober living)
Prospective Move-In Date  (estimate is ok)
Room Preference 
*There are a few single transitional beds for $800-$900, but they are based on seniority and progress.  Everyone begins in the shared rooms.
**Transitional rooms include structure and support by means of Grassroots Recovery Collective.  They are intended to be a stepping stone to the next juncture and stays are limited to 6 months.  We are often full, but there is turnover and we can add you to a wait list.  ***Members who do well in the transitional apartments are encourage to move to the next tier of the Vibe Recovery Co-op
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Sobriety Date
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Drug(s) of Choice (include behavioral addictions, e.g. gambling)
Recovery Experience (recent treatments, sober living, 12-step program, etc.) 
Employment (other sources of income? are you a full-time student?)

Current Legal Conditions (probation, parole, re-entry, etc.)
*this information will NOT be held against you.

Physical and Mental Health Information (allergies, accommodation needs, pertinent diagnoses, etc.)
*this information will NOT be held against you.
Kids and Custody  (how many? ages, what is your custody/ visitation arrangement?)
Emergency Contact Name and Phone Number
Questions and Additional Information
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