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Somerset Sober Living Application
After submitting this application you will be contacted no later than the next business day
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Name
Your answer
Date
Your answer
Best Phone Number to Contact you
Your answer
Date of Birth
Your answer
Sex
Your answer
Describe Your Current Living Situation
Your answer
Drug of Choice and last used when?
Your answer
Do you have any physical health/medical conditions or disabilities. Please list.
Your answer
How many years have you been using alcohol and/or drugs?
Your answer
Are you currently using any prescription medication? Please list.
Your answer
Do you have any previous felonies or misdemeanors? Please also list any ongoing legal issues.
Your answer
Are you able to be employed for at least 31 hours weekly, make recovery meetings, and participate in household chores?
Your answer
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