Spangler Manor Application for Residency

 

Dear Future Resident,
Congrats, today you choose life! What an important decision. Making the
decision to go from a life of addiction to a life of recovery and rebuilding is the
most important decision that you will ever make, and we are so honored that you
have chosen to share this journey with us! Life is meant to be enjoyed not
endured, at Spangler Manor we want to love you and surround you while you
learn to enjoy life and live a life worth living instead of merely surviving. Please
provide the information below, and someone will reach out to you right away. You can email your applications and any questions you may have to Soberatspangler@gmail.com

 

Name:

Date of Birth:

Address:

Phone number
where you can be reached:
If you are
incarcerated,
please list your
person of
contact. (Please
provide the name
and number of
this person):

Marital Status:

Does your
significant other
struggle with
addiction? Are
they safe and
sober?

How long have
you been sober?

Have you
completed detox
or treatment
anywhere? If so,
please provide
names and
dates:

 

What is your path
to recovery (AA,
NA, Smart
Recovery,
Celebrate
Recovery, etc.):

Sponsor’s Name:
Who are your supports:

Are you on any
type of
supervision?

Do you have any
pending
charges? Please
list all details
pertaining to this,

including the
county and
charge):

 

If so, please
provide the name
and all known
contact info for
this person:

Do you have
children? If so,
please list names
and Dates of
Birth:

Who do your
children live
with:

Do you have an
open DCS case?
If so, please list
the Case
Manager’s name
and County:

Substance Abuse
History:
Please explain
the progression
of your addiction.
(When it began
and with what
substance and
where your
addiction is now):

 

What one piece
of advice would
you give your
sober self?

 

What are your
triggers?

 

What are 3
strengths you
have:

 

What are 3
weaknesses you
have:

 

Please list 3
goals, 2 short-
term goals, and 1
long term:

How long do you
intend to stay at
Spangler Manor:

'
In case of
Emergency
Contact
Information:

 

Please take this
space to
introduce
yourself to the
staff at Spangler
Manor and why
you want to be
here:

 

 

 

 

Date:

Signature:

 

Printed Name: