Housing Waitlist Application

 

Recovery Homes

APPLICATION PROCESS:

  1. Complete application and submit form (if referred by county agency, referral form with supervisor signature must accompany application for billing purposes).
  2. Complete interview with director of operations.
  3. If accepted, arrange time and date of arrival.

Application Date:


Have you done any programing with Restorative Partners?

Yes
Mentor Program
AVP
Yoga
Art
Thinking for a change
Other
No

Personal Info:

   Male         Female


Address:


Are you able to pay for a part of your treatment/membership?

   Yes         No

Legal Status

Are you currenty incarcerated?

   Yes         No

If yes, where?

If yes, what is your release date?

If yes, are you involved in any legal action?

   Yes         No

Treatment History - check all that apply

Are you receiving alcoholism/drug addiction treatment?

   Yes         No

Select all that apply to your treatment history.

Drug Court
Prop 36
AB109
POEG
ATCC
BATC
Self-Referral

Have you been treated at any of these locations?

SLO
North County
South County

Is your rent funded through your treatment program?

   Yes         No

Contacts - Fill in all that apply

Drug History

Please describe your pattern of drug and alcohol use in the last 30 days:

How long since you've used drugs or alcohol

What did you use last?

How long has using drugs and/or alcohol been a problem for you?


Employment


What day would you like to move in?

Membership Dues of $900.00 or pro-rated to $30.00 per day for mid-month move-in must be paid on or before the day of arrival. (AB-109 or SLO County paid beds are exempt as per contract)


Housing Coordinator, Los Osos Homes

Gus Chavez
Phone: (805) 242-1272
Fax: (805) 834-0046
gusl@restorativepartners.org
www.restorativepartners.org

How Can I Help?

Restorative Partners can only serve through the generosity of individual and groups who have a heart for our mission. We need your help!

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Contact Info

Restorative Partners

3220 South Higuera, Suite 103A
San Luis Obispo, CA 93401

(805) 242-1272

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