Reset. Rise. Rebuild.

Screening Questions

These questions help us get to know you and make sure our home is the right fit. There are no wrong answers — be honest, and share only what you're comfortable with. Everything stays private with our team.

01About you

Full name *

Phone number *

Email address *

Date of birth

02Housing history

Where are you staying right now? *

How long have you been without stable housing?

Have you lived in shared or transitional housing before?

If yes, where and why did you leave?

03Recovery & wellness

Are you currently in recovery from substance use?

Sobriety / clean date (if applicable)

Are you working with any counselor, program or support group?

Any medical or mental health needs we should plan for?

04Income & responsibilities

Are you currently employed?

Monthly income (approximate)

Can you pay a weekly or monthly program fee?

Do you have a valid photo ID?

05Legal & safety

Are you on probation or parole?

Officer name and phone (if applicable)

Are you currently fleeing domestic violence?

Anything about your legal situation we should know?

06Goals & house life

What are your goals for the next 6 months? *

Are you comfortable sharing a room and following house rules (curfew, chores, meetings)? *

What does a safe place to heal mean to you?

Anything else you want us to know?

I confirm this information is accurate and agree to be contacted by Pathway to Hope Foundation about my screening.