Sober Living Housing Certification Application

"*" indicates required fields

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

Sober Living House President/ Owner

A Current or prospective client by the name of (below) has requested funds from HOPE Sheds Light to cover the move-in expenses to your sober living home.

Client Name*

We request that you please complete the following so that we may process the application.

Is this individual receiving funding from any other sources?*

Yes

No

If yes, how much?

House Information:

House Name*

House Address*

House President/ Owner Information

House President/Owner Name*

House Name*

Total Move-in Fee Amount to Become a Resident*

Move-in Date*

Signature*

Title*

Date*

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