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Location
Eligibility
Expectations
Application
Contact Us

Now accepting interest for upcoming openings.Click Here to Apply Now!

Join Our Community of Stability & Growth

We make the application process simple, confidential, and welcoming. Completing this form helps us understand your background and goals so we can ensure AnchorRoc Living is the right fit for your needs.

Whether you’re transitioning from treatment, reentry, or other structured programs—or simply seeking a safe, sober, and supportive home environment—we’re here to help you take the next step toward independence and stability.

Steps to Apply

Submit Application: Fill out the online form below.
Phone Interview: We’ll reach out to discuss your goals and background.
Tour & Acceptance: Once approved, we’ll schedule a move-in date.

Applicant Info (demographics):

I agree to terms & conditions provided by AnchorRoc. By providing my phone number & email address, I agree to receive text messages, phone calls, & emails from AnchorRoc.

First Name *

Last Name *

Applicant Email *

Applicant Phone *

Date of birth *

Street Address *

City *

State *

Postal code *

Marital Status *

Driver's License # or NY ID #: (if suspended or revoked, please put N/A) *

Sobriety Date *

Addiction History (please list all drugs used): *

Do you have a Case Manager? *

Yes

Case Manager Name

Case Manager Email Address:

Case Manager Phone #:

Have you ever been in a treatment program? *

Yes

If yes, what was the most recent treatment start date: *

Length of Stay

Did you complete the program?

Yes

Treatment center name & address:

Have you ever lived in a recovery home? *

Yes

Recovery home name & address:

Reason for leaving

Are you currently attending 12 step meetings? *

Yes

If yes, how many per week?

Education: *

No HS Diploma & No GED

High School Diploma or GED

Some College

College Graduate

Other

Why do you want to live in a sober house? *

How did you hear about us? *

What other information should we consider when reviewing your application?

Filler

Emergency Contact Information

Emergency Contact Name: *

Emergency Contact Relationship: *

Emergency Contact Phone #: *

Emergency Contact Address:

Filler

Financial Information

Are you capable of paying rent or monthly dues? *

Yes

Other

How will rent, dues, or any other fees be paid? *

Are you currently employed? *

Yes

Current Monthly Income $ *

Current Employers Name & Address

Are you capable of working/volunteering? *

Yes

List any Work Experience (What do you do for employment. Trades, Degrees, Special skills and Training) *

Filler

Chemical Use History / Legal Involvement

Are you court ordered to be in a sober house: *

Yes

Criminal History (Check all that apply from your lifetime) *

I have no criminal history

I am currently on Probation

I have been charged with a Violent Crime

I have committed or have been charged with Arson

I have a Sex Crime conviction

I am on Ankle Monitoring

Other

If you have answered yes to any of the above, state in detail the circumstances of the offense(s)

Do you have a Parole Officer / Probation Agent? *

Yes

If yes, what is their name and contact information?

Number of lifetime DWI's / DUI's: *

Have you previously been convicted of a felony? *

Yes

If yes, explain the offense, date, and state/county:

Filler

Physical & Mental Health

Please list ALL allergies *

Please list ALL medications in your possession. These are both prescription and non-prescription (such as Tylenol, cold medication, etc.) *

Are you under a physician’s care? *

Yes

Doctor(s) Name and Phone number:

Are you under the care of: *

Psychologist

Psychiatrist

Therapist

Other

None

If yes, what are their Name(s) and Phone number(s):

List any Psychiatric diagnosis*

Have you ever planned suicide? *

Yes

Have you ever attempted suicide? *

Yes

Please list any medical issues/ medical concerns that an emergency response team may need to know about (allergies, high BP, etc.):

Filler

References

Please list two (2) references that are familiar with your life and current situation.

Reference #1 Name *

Reference #1 Years Known *

Reference #1 Phone number: *

Reference #1 Relationship to you: *

Reference #1 Address:

Reference #2 Name

Reference #2 Years Known:

Reference #2 Phone number

Reference #2 Relationship to you

Reference #2 Address

Filler

Agreements

Any comments or additional information you would like to add:

Upon acceptance, you will be expected to enter into an Agreement wherein you will agree to abide by certain rules and standards of conduct. Do you acknowledge this expectation? *

Yes

Applicant Signature *

Clear

Today's Date *

*** If nothing happens after pressing "Submit", please scroll up in the form to see if any required fields (marked w/ an asterisk * ) are blank or if there are any errors (highlighted in red).