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Waitlist for Holistic Coaching Housing
Openings are Currently Available
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Potential Resident's Name
Name and Title of Person completing this form- If different from above.
Contact Email
Contact Person Phone
Room Type
Choose all that apply to the potential resident:
Mental Health Diagnosis
History of Addiction
Willing to submit to random drug and alcohol screens
Have a stable form of employment
Has someone willing to sponsor your payment or social security income
Willing to engage in social activities with other residents
Willing to engage in social activities alone
Give us additional details about your housing needs and current situation.
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