Apply | AnchorHer

Apply to AnchorHer

All applicants must complete the AnchorHer application below. If you need housing assistance, you must also complete the appropriate funding application. Completing an application does not guarantee funding or placement at AnchorHer. All applicants must be screened and approved before admission.

Are you completing this application yourself or on behalf of an applicant?

I am the applicant

Case manager or referring professional

Family member

Probation or parole Officer

Friend or support person

Full Name

Phone Number*

Date of Birth

Email address

Employment or Income Status

What substances have you used with in the last 12 months?

Sobriety Date

Emergency Contact Name and Phone Number

Are you currently engaged in recovery support, treatment, or counseling?

Counseling

Outpatient treatment

Recovery Meetings

Case Management

None Currently

Referral Source

Name and email of referring agent

Are you willing to complete drug and alcohol testing at intake and random testing during residency?

Are you willing and able to live cooperatively in a shared home and share a bedroom with another woman?

Yes

No

Do you have any pending charges, upcoming court dates, active warrants, probation, or parole requirements

Yes

No

If yes, please explain.

Have you had any recent incidents involving violence, threats, property damage, or removal from shared housing

Yes

No

If yes, please explain

How will your program fees be paid?

Self-Pay

Funding agency

Family or Sponsor

Unsure

Do you currently have reliable transportation to work, appointments, treatment, and recovery meetings

Yes

No

Are you currently taking any medication?

Yes

No

If yes, please explain

I understand that AnchorHer is a non-medical recovery residence and does not provide detoxification transportation, or 24 hour onsite supervision for residents and property saftey, common areas are monitred by 24 hour surveallance

Yes, I understand

No, I do not understand

Is there anything you would like us to know before follow-up?

I have read the Resident Handbook and Terms and Condiiton

Yes

No

Does the applicant know about and consent to this application being submitted

Yes

No

Eligible veterans may apply separately for housing funding through SCARR

If you are coming from treatment or rehabilitation and do not currently have stable income, you may apply for Recovery housing assistance through DAODAS. If you apply, list AnchorHer as the recovery residence. Please note. Funding is currently available only to applicants ages 18-24 The General adult funding application is temporarily closed

Housing Assistance

Veterans Housing Assistance

Resident Handbook

Applicants required to register as sex offenders are not eligible for placement at AnchorHer's. Please review AnchorHer's Resident Handbook and terms and conditions before submitting an application.

Terms & Conditions

Referral Guide

Referring agencies: Please review the Referral Guide and Terms and conditions before submitting and application or referring a client to AnchorHer

Veterans Funding