Resident Application | Reset Ministries

Fields marked with * are required

First & Last Name*

Birth Date*

Email*

Phone #*

How did your hear about Reset?*

If accepted, when would you be able to move in?*

What other types of programs/facilities have you contacted?*

Please list all convictions and dates*

Terms of Parole / Probation (if applicable)

Do you have a significant other?*

Do you have children? *

If yes, where do they live now?

Do you have any sources of income?*

What types of jobs have you done in the past?*

Do you have a trade? Do you have any formal schooling?

Have you ever served in the military?*

If yes, which branch?

If yes, when were you discharged?

Legal Issues*

Do you have any upcoming court dates?

If yes, please explain.

Are you a registered sex offender?*

Substance Use*

Reset is a next step recovery house built for people that have some roots in recovery and spirituality and are ready for a next level of care. Some program of recovery along with at lease 30 days drug and alcohol free are a requirement for admittance. Knowing this, please describe any programs you have completed currently or recovery groups you actively participate in:

Can you recall the last time you used drugs or alcohol?*

If yes, when?

During the last 24 hour period that you used, what substances did you use and how much did you use?

Have you ever tried to stop using before?*

Did you experience any medical complications?*

If yes, please explain.

Have you ever been in a treatment program or a detox facility? *

If yes, when and where?

What is your primary drug addiction?*

Date of last use?*

What is your secondary drug addiction?*

Date of last use?*

What age were you when you started using alcohol and/or drugs?*

Do you have any physical disabilities?*

If yes, please explain.

Are you currently taking any medications?*

If yes, please explain.

Reset is a Next Step recovery house built for people that have some roots in recovery and spirituality and are ready for a next level of care. Some program of recovery along with at least 30 days free of drug and alcohol use are a requirement for admittance. Knowing this, please describe any programs you have completed and what currently you are doing toward active participation in your recovery.*

Reset is a recovery ministry rooted in a faith in something bigger than ourselves--specifically the Good News of Jesus Christ. Although being a Christian is not a requirement for admittance, we do ask that all potential residents be open to hearing more about the Story of God and how you fit into that story. Please tell us about your faith background, including any churches you have been a part of. *

Before submitting your application, view policies here: https://www.resetministries.org/policies*

I have reviewed Reset's policies.

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