Hope Sheds Light Housing Application

"*" indicates required fields

Email

This field is for validation purposes and should be left unchanged.

Gather Required Documents

Documentation*

Completed Application

Identification or Proof of Residence

Signed Letter to Sober Living House

Personal Information

Full Name*

Phone*

Email*

Date of Birth*

Current Address*

Previous Address

(If less than 6 months)

Are you a Parent?*

Yes

No

Do you have any pending charges?*

Yes

No

Employment Status*

Emergency Contact:

Emergency Contact Name*

Relationship:*

Emergency Contact Phone Number*

Treatment Information

Treatment Agency:*

Counselor's Email:*

Counselor's Phone*

Other Important Information:

Treatment Discharge Date:*

Are you continuing treatment post completion?*

Yes

No

What house have you been accepted into?*

How much funding are you seeking?*

Are you receiving funding from any other organization?*

Yes

No

If Yes, how much?

Have you been funded by Hope Sheds Light previously?*

Yes

No

Signature*

Today's Date*

Please email the additional required document’s to courtney@hopeshedslight.org.

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