We are ONLY accepting new applicants who’ve achieved the following criteria to ensure the utmost success for our residents.

• A combination of six months clean and a successful graduation from Halfway Housing. OR

• Six months clean and completion of a State Drug Treatment Program with certification.

OR

• Six months clean with current involvement in the Treatment Court Program.

• Able to pay $840 Monthly or $196 weekly via automatic withdrawal. Utilities, internet access included.

 

TODAY’S DATE: ______________________________________________________________

 

NAME: _______________________________________________________________________

 

DATE OF BIRTH: ­­­­­­­­­­­­­­­­­­­­­­­­­­_________________________ CLEAN DATE: ­­­­­­­­­­­­­­­­­­­­­­­_______________________

 

INPATIENT TREATMENT FACILITY ­­­­­­­­­­­­­­­ ____________________________________________

 

_______________________________________________________MAT __________________

 

ENTRY DATE: ___________________________ DISCHARGE DATE: _________________

 

COUNSELOR PHONE NUMBER: ________________________________________________

 

COUNSELOR EMAIL: __________________________________________________________

 

PAROLE/PROBATION OFFICER: ________________________________________________

 

CONTACT EMAIL/NUMBER: ___________________________________________________

 

______________________________________________________________________________

 

CHARGES: ___________________________________________________________________

 

PENDING CHARGES: __________________________________________________________

Drug Screening Policy:

RESTORATION HOUSE HAS A ZERO TOLERANCE POLICY!

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1. Residents are required to participate in treatment, self-help groups, or other drug and alcohol recovery supports.

2. Residents must abstain from the use and sale of alcohol and illicit drugs.

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Consequences for drug/alcohol usage.

• Participant agrees to submit to observed drug screening and/or breathalyzer within a reasonable period of 1 hour upon request.

• Participant agrees to leave the premises immediately upon refusal to submit observed drug screen or

• Participant agrees to leave the premises if the drug screen or breathalyzer result is positive for alcohol or

• Failuretopassdrugscreenand/orbreathalyzerwillresultinparticipantbeingdischarged

• Participantsareresponsibleforcostsof

• Every effort will be made to refer the offender to more suitable programming.

 

 

DISQUALIFYING OFFENSES

 

For the safety of residents and staff, individuals with the following convictions are not eligible for residency at Restoration Homes of Erie/Restoration House

 

- Registered or convicted sex offenses

 

- Homicide or attempted homicide

 

- Arson

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- Crimes against children (abuse, endangerment, exploitation)

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- Active violent felony convictions within the past 5 years

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ALL APPLICATIONS WILL BE REVIEWED ON A CASE-BY-CASE BASIS.

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SUBMIT REFERRALS TO: vperkins@restoratorationhomesoferie.com