Get In Touch

Application Form

Please enable JavaScript in your browser to complete this form.

We are an inclusive women's home. Please complete the intake for to the best of your ability. Your admittance and continuation in the program requires that this information meets our minimum criteria AND is a truthful notation of your current journey towards recovery.

Do you identify as a woman:
Do you have a vehicle that you plan to bring to our property if you are accepted:
Legal Name
Which of the following substances have you used in the past six months? Check all that apply. **PLEASE NOTE: Each client is accepted on a case-by-case basis, the information you provide is to help us place you in the best location, not judge your past. *
Since the age of 18, what is your longest period of non-use?
Are you able and willing to work full/part time? If no, please explain.
Are you currently on probation or have pending charges? If yes, please describe.
Do you have any physical needs we should know about? If yes, please specify and include any necessary accommodations.
On a typical day, are you physically capable of walking 6 blocks and up and down 2 flights of stairs?
Do you have any mental health needs we should know about (including phobias and obsessive behaviors)? If yes, please specify.
Permanent Address:
Do you have child(ren):
Which Glass House location(s) are you applying to:
If you selected multiple locations, do you want the first available bed?
Have you ever lived in a sober living home/recovery residence? If yes, specify and describe.

Expectations (NOTE: We have a zero tolerance program):

1) New applicants will be welcomed once they have an adequate number of days clean and sober and are actively attending at least three (3) Twelve Step Meetings per week.

2) New residents will attend a weekly in-house meeting to discuss concerns that affect all members of the household and to share personal gratitude lists.

3) New residents will structure their stay and maintain meaningful routines including a sincere and quality commitment to doing their assigned household chores.

4) For the safety of everyone, entry doors will be locked at 11:00pm every evening. Only residents are allowed in the house – any exception to this safety issue must be in writing and signed by the Owner or House Manager documenting approval.

5) Smoking is permitted only in designated outside areas.

6) Civility and good manners are important aspects of recovery. Anytime communication between residents becomes ineffective, hurtful, or attacking it is suggested that those involved take a thirty-minute break. This is often enough time to give each person the chance to look at her own part in the disagreement. Remember that the 12 Steps and 12 Traditions teach us that we can always begin again.

7) If at any time you test positive on an alcohol or drug screening test, and/or the Owner or House Manager requests for you to leave the house because you are behaving in an unsafe or threatening manner, by the signing of this document, you agree that you will willingly leave the house within one (1) hour. We will offer you support in getting to a treatment program for more intensive care.

8) Our waitlists are very long, as such, we do not reserve beds without a holding payment. The management team will do their best to accommodate you. Management reserves the right to update or change house expectations.

9) All payments or donations are final.

By continuing, you agree that your electronic signature is the legally binding equivalent to your handwritten signature. Whenever you execute an electronic signature, it has the same validity and meaning as your handwritten signature. You will not, at any time in the future, repudiate the meaning of your electronic signature or claim that your electronic signature is not legally binding.