Sober Living Request Form - Bring on the Ministry

Current Living Situation (check one)

Street/Unsheltered Shelter Staying with friends/family Hospital/Detox/Residential Jail/Probation-related housing Motel Other (please explain)

Is the applicant in immediate crisis?

Yes No

Any current safety concerns (DV, trafficking, threats, unsafe home)?

Yes (please explain) No

2) Identification, Communication, and Logistics

Florida ID/Driver License available?

Yes No In process

Social Security Card or number accessible?

Yes No In process

Reliable phone access?

Yes No

Transportation to house/work/appointments

3) Recovery Status & Readiness

Primary substances of concern (optional)

How is sobriety supported right now? (check all that apply)

Sponsor or recovery mentor

Yes No In progress

Name of Sponsor (optional)

Phone for Sponsor (optional)

How many meetings per week?

Willing to follow sober living rules (curfew, chores, meetings, random testing)?

Yes No Unsure (please explain)

Any recent relapses?

Yes (please explain) No

If yes, when and what supports are in place to reduce risk?

4) Sober Living preference (House Match)

Which Sober Living homes are they interested in?

Option 1 (Preferred Location)

Preferred move-in date

Any accommodations needed? (mobility, medical, dietary, etc.)

Yes (please explain) No

Any restrictions that affect placement?

5) Income, Employment, and Payment Plan (Required)

*Applicant must have a realistic plan to pay program fees after entry

Current income source(s) (check all that apply)

Pay schedule

Weekly Biweekly

Estimated take-home per paycheck

If unemployed: job search plan and timeline (required)

Monthly Budget Snapshot

Estimated monthly income

Total estimated monthly expenses

Child support payment

Probation/court fees

Other (describe below)

Housing Payment Plan (required)

House weekly fee (if known)

How much can applicant pay starting Week 1?

How much can applicant pay starting Week 2-4?

Full weekly payment expected by (date)

Plan to reach full payment (employment/benefits/increase hours/support)

6) Case Management & Services

Does the applicant have a Case Manager?

Yes No

Current supports/services (check all that apply)

Required appointments that could affect work/house schedule

Any current legal involvement?

Yes No

If yes, check all that apply

Details/requirements (curfew, travel limits, check-ins)

Background considerations (only if required for placement):

Any history that would block entry into certain houses?

Yes No Unknown

8) Strengths, Goals, and Motivation

Top-3 strengths the applicant brings to recovery:

90-day goals (employment, sobriety, savings, reunification, etc.)

Why does the applicant want sober living now?

9) Verification Attachments (if available)

Check all that apply

10) Applicant Acknowledgment & Consent

I understand that funding assistance (if approved) is temporary and/or conditional, and I must follow house rules and my payment plan. I agree to communicate with my case manager and the house leadership to maintain eligibility.

Applicant Signature:

Staff/Case Manager Signature:

Consent to Release/Exchange Information (optional but recommended):

I authorize Bring On the Ministry to communicate with my referring agency/case manager and the sober house for the purpose of placement and funding coordination.

Yes No

For Office Use Only (Bring On the Ministry)

Initial eligibility decision

Approve Deny Waitlist Need more info

Funding type

Move-in Week-to-week Partial scholarship Other (explain)

Conditions (job search, meetings, testing, savings plan, etc.)

Sober Living Funding Referral Request & Eligibility Screening Form

Complete this form and CLICK SEND AT THE BOTTOM to apply for assistance with placement and funding towards sober living housing. Someone will be in contact within 24 hours.

All requests are subject to review and approval.

* Funding assistance (if approved) is temporary and/or conditional.

1) Current Housing & Immediate Need

2) Identification, Communication, and Logistics

3) Recovery Status & Readiness

4) Sober Living preference (House Match)

Which Sober Living homes are they interested in?

5) Income, Employment, and Payment Plan (Required)

*Applicant must have a realistic plan to pay program fees after entry

Employment status:

If unemployed: job search plan and timeline (required)

Monthly Budget Snapshot

Housing Payment Plan (required)

6) Case Management & Services

7) Legal/Compliance

Background considerations (only if required for placement):

8) Strengths, Goals, and Motivation

Top-3 strengths the applicant brings to recovery:

9) Verification Attachments (if available)

10) Applicant Acknowledgment & Consent

I understand that funding assistance (if approved) is temporary and/or conditional, and I must follow house rules and my payment plan. I agree to communicate with my case manager and the house leadership to maintain eligibility.

Consent to Release/Exchange Information (optional but recommended):

For Office Use Only (Bring On the Ministry)

Please review all information and click SEND

Sober Living Funding Referral Request & Eligibility Screening Form

*Complete this form and CLICK SEND AT THE BOTTOM to apply for assistance with placement and funding towards sober living housing. Someone will be in contact within 24 hours.*All requests are subject to review and approval. * Funding assistance (if approved) is temporary and/or conditional.

1) Current Housing & Immediate Need

2) Identification, Communication, and Logistics

3) Recovery Status & Readiness

4) Sober Living preference (House Match)

Which Sober Living homes are they interested in?

5) Income, Employment, and Payment Plan (Required)

*Applicant must have a realistic plan to pay program fees after entry

Employment status:

If unemployed: job search plan and timeline (required)

Monthly Budget Snapshot

Housing Payment Plan (required)

6) Case Management & Services

7) Legal/Compliance

Background considerations (only if required for placement):

8) Strengths, Goals, and Motivation

Top-3 strengths the applicant brings to recovery:

9) Verification Attachments (if available)

10) Applicant Acknowledgment & Consent

I understand that funding assistance (if approved) is temporary and/or conditional, and I must follow house rules and my payment plan. I agree to communicate with my case manager and the house leadership to maintain eligibility.

Consent to Release/Exchange Information (optional but recommended):

For Office Use Only (Bring On the Ministry)

Please review all information and click SEND

Complete this form and CLICK SEND AT THE BOTTOM to apply for assistance with placement and funding towards sober living housing. Someone will be in contact within 24 hours.

All requests are subject to review and approval.

* Funding assistance (if approved) is temporary and/or conditional.