Sober living facility for men in the Mid-Ohio Valley

We offer a 6-12 month program that assists men in developing the recovery time & life-skills needed to advance into mainstream society. Our program is highly structured with sound mentorship & required weekly meetings which includes: 3 intensive outpatient programs (IOP's) & 5 AA meetings. If you are not willing to commit to the 6-12 month timeframe as well as the required meetings, then please do not apply. *

I agree to do all the above

Name *

First Name

Last Name

Date of birth *

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DD

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Your best phone number *

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Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Status *

Please check the box for all that apply:

I am currently on parole

I am currently on probation

None of the above

Have you been convicted of any felonies or misdemeanors? *

Yes

No

Are you on The National Sex Offender Registry *

Yes

No

Have you ever been convicted of a violent crime? *

Yes

No

Do you currently have a job? *

Yes

No

Phone Number

(###)

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Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Do you have any medical issues that will prevent you from being employed? *

Yes

No

Are you receiving public assistance or any non-job related income? *

Yes

No

Do you pay child support? *

Yes

No

Are you in arrears in child support? *

Yes

No

Have you completed a treatment program of at least 28 days? *

Yes

No

Do you have any of the following blood disorders? *

HIV

STD

Hepatitis C

Hepatitis B

None

If yes to any of the above blood disorders, are you being treated? *

Yes

No

Does not apply

Do you have at least two forms of proper ID? *

Yes

No

I understand there is a move in fee of $125 which pays for my 1st 2 weeks. This is payable on or before I move in. *

Yes

I understand that rent of $110.00 is collected weekly & will start in week #3. *

Yes

After submitting application, please have your case manager (if applicable) call 681-321-3981 to discuss it & to give us your discharge date. *

I will

We accept MAT programs, but do not accept methadone. I state I am not on methadone *

I am not on methadone

I understand that failing a drug screen may result in being expelled from The Key & no refund on any paid rent will be given *

Yes

Today's Date *

MM

DD

YYYY