Apply to Nadezhda

Begin Your Application

We review each application personally. Completing this form is the first step toward joining our community.

Applicant Information

Full Name

Email Address

Phone Number

Date of Birth

Current Address

City

State

Zip Code

Recovery Information

Primary Substance of Use

Are you currently in treatment?

Have you previously attended treatment?

Do you currently attend recovery meetings or work with a sponsor?

Medical & Safety Information

Do you have any current medical conditions?

List all current medications (prescription and over-the-counter)

Do you have any current legal issues?

Are you required to register as a sex offender?

Housing & Payment

Expected Move-In Date

How do you intend to pay?

Do you have a valid form of identification?

Emergency Contact

Emergency Contact Full Name

Relationship to Applicant

Emergency Contact Phone Number

Emergency Contact Email

Final Questions

Why are you interested in living at Nadezhda Houses of Hope?

What are your recovery goals at this stage of your journey?

Is there anything else you would like us to know?

Consent & Signature

I understand that submitting this application does not guarantee admission and that Nadezhda Houses of Hope may contact me for additional information.

Signature (type your full name)

Date

Fields marked with * are required.

Apply to Nadezhda

Begin Your Application

Application Submitted