Resident Application

Complete the application below on your phone or computer. All information is kept confidential. It takes about 10 minutes.

Dallas, TX 75215 5 sections · ~10 min
  1. 1Applicant
  2. 2Sobriety
  3. 3Address & Legal
  4. 4Bed Agreement
  5. 5Review
  6. 6Submit
Applicant Details

Please complete all fields. Information is kept confidential.

Your Information

Emergency Contact

Veteran Status

Are you a veteran?
Receives VA disability compensation?
Additional help

Level of Education

Education level
Sobriety & Treatment

Substances Used / Abused

Check all that apply.

Substances
Been to treatment / rehab?

Treatment History

List up to 3 past programs.

Program TypeCity, StateYearCompleted?

Recovery Support

Currently attend 12-Step groups?
If not, willing to attend?
Address, Legal & Employment

Most Recent Address

Legal Status

Currently on probation / parole?
Currently has a warrant for arrest?
Have a lawyer for these offenses?
Need help obtaining one?
Charged with a sex-offense-related crime?
Ever charged with a violent crime?

Employment / School Status

Vehicle Information

Do you have a vehicle?

Applicant Certification

I verify that the information provided in this application is true and correct to the best of my knowledge.

Access to a Bed Agreement

This agreement is not a lease. Initial each rule and sign on the final step.

By initialing each rule and signing this agreement, I agree to follow the rules to obtain access to a bed at 4934 Echo Avenue, Dallas, TX 75215. I understand that failure to follow the rules may result in revocation of bed access.

Type your initials once and tap the button to apply them to all 34 rules. You can still change any individual initial.

Final Signature

By signing, I acknowledge that this is an Access to a Bed Agreement and not a lease. I understand that bed access may be revoked if I violate the rules above.

Review & Submit

Please review your information below, then submit. Your application will be sent to Bridgeway Living for review.