Residential Program Application

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**Though Hope Alive does not allow children to live in our apartments, we want to understand your family.**

Race/Ethnic Background

Education & Occupation Information

Housing History

Physical Health History

Mental Health History

**Please note, we will require a release to coordinate with your current counselor/care provider.

I understand that, due to the nature of a transitional living program with the goal of aiding women to become self-sufficient, I acknowledge that I am physically and emotionally capable of doing all household and yard chores. I understand that if at some point I become unable or unwilling to do these chores I will be required to leave this program.

I understand that I am going to be given a drug and alcohol screening prior to being admitted to Hope Alive’s Residential Program. I also certify that the above information is true and accurate to the best of my knowledge. I understand that falsified information may be cause for my dismissal from Hope Alive’s program.

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Today's Date


  • Absolutely no drug, alcohol or prescription narcotics (even if prescribed by your physician) are allowed on premises – you MUST provide a NEGATIVE urine/breathalyzer at any time.
  • Absolutely no weapons of any kind are allowed on the premises.
  • Violence or threats of violence will not be tolerated.
  • Be respectful and courteous to each other, staff, and neighbors.
  • Stealing will not be tolerated.


  • Part of transitional housing is learning responsible property maintenance and upkeep, including yard work, snow removal, leaf removal, and overall upkeep of the yard. Therefore, ALL RESIDENTS are required to share in the responsibility of these tasks. Yard work will be assigned on a rotating basis, and all residents will be expected to take turns with each task, including mowing.
  • Residents are expected to keep their rooms and common areas clean, including taking part in dish washing, trash removal, and other household chores.


  • ALL personal property must be kept in an orderly fashion. Make sure you comply with space and storage rules (no moving furniture in or out etc.).
  • All rooms, your person, and your vehicle are subject to inspection at any time.
  • Upon check-out, all personal property must be taken with you. Anything left behind will be discarded.
  • No personal furniture is allowed to be brought into the apartment or personal rooms at any time. Small flat-screen TVs are allowed.


  • To maintain cleanliness of Hope Alive, when moving in, all personal items will be placed in a “bug zapper.”
  • Rent is due by the 3rd of each month. All accrued rent charges are required to be paid, including any remaining balance, upon exit from Hope Alive.
  • Residents must attend 2 groups, case management, and counseling weekly and must be on time.
  • Supervised urine drug screens and breathalyzers will be administered upon interview, at admission, and at random throughout your stay at Hope Alive.
  • Smoking and vaping are discouraged but allowed in the designated area only. No smoking or using tobacco products (including vaping and e-cigarettes) is allowed in apartments.
  • To spend a night away from Hope Alive, residents must have been at Hope Alive at least 2 weeks, be working at least 15 hours, and request approval via Overnight Pass Request. Please note: residents on a problem-solving court (drug court, mental health court, hope probation, etc.) must gain approval through the court first.
  • Residents that are not working at least 15 hours per week are required to participate in work study at Hope Alive.
  • Residents are expected to take medication as prescribed.
  • Remember, confidentiality is a MUST.
  • Pets are prohibited.
  • Residents must supply their own toiletries, paper products (including toilet paper, paper towels, etc.), cleaning supplies, laundry products, etc. Everyone is to contribute her fair share. If you need help with this, please see the office.
  • Curfew hours are Sunday-Thursday at 11pm and Friday and Saturday at 12am.
  • Quiet time is 9:30pm-7:30am. Visitors, including residents from other apartments, are not permitted during this time.
  • Anyone choosing not to fulfill their responsibilities to Hope Alive, or not complying with these expectations will be asked to leave Hope Alive.


By signing below, I, a potential or admitted resident of Hope Alive, acknowledge that I have read and understood all the above expectations and am willing, able, and agree to abide by them. I understand that failure to abide by these expectations may result in my being asked to leave Hope Alive.

Please Type you full name. This will server as your signature
Today's Date