Apply - Anchor Point Transitional Homes

Application Form

Take the first step toward your recovery journey. Please complete the application below, and a resident will contact you to schedule an interview.

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address *

Current Address

City

State

ZIP Code

Contact Name *

Relationship *

Emergency Contact Phone *

Date of Last Substance Use * This information is confidential and helps us support your recovery.

Are you currently attending recovery meetings? *

Have you completed a treatment program? *

Are you currently on Medication-Assisted Treatment (MAT)? * MAT is permitted with valid prescription documentation.

Current Employment Status *

Can you afford the weekly fee of $125 plus $150 entrance fee? *

Do you have any pending legal issues? *

Please provide brief details

Do you have any criminal history? *

How did you hear about Anchor Point?

Why are you interested in joining Anchor Point? *

Is there anything else you'd like us to know?

I understand and agree to Anchor Point's zero-tolerance policy for substance use and violence. *

I agree to drug screening upon entry and weekly screenings during the first 30 days. *

I understand the requirements: employment, 4 weekly recovery meetings, chores, and house meeting participation. *

I certify that all information provided is true and accurate to the best of my knowledge. *