Housing Application

To be accepted into SHIP Housing an applicant must complete all questions in this application and be interviewed by the SHIP staff. Phone interviews can be arranged if needed.

Carefully read the application and honestly answer the questions.  SHIP provides separate facilities for Men and Women.  Safe and Sober Housing is a step down program that does not have a predetermined length of stay - how long you stay depends on you, your needs, and your source of funding.

Is this a duplicate application?*
Type of Housing*
Special Programs
When do you need housing?*
When will you need housing?
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Name:*
Phone:
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E-mail:
Marital Status
Date of Birth*
Address:*
Have you used any other names or aliases?*
Please list any/all names you have used in the past
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Are you employed?*
What do you expect your income to be next month?*
Who is your employer?
How many hours per week do you work?
Each member of the house is required to pay their share of the housing expenses. What is your source of income? (please list)
If you are not currently employed, you are required to participate in SHIP's Work Skills Program. Reasonable accommodations will be made for persons with disabilities.
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SHIP Houses are Recovery Homes and require that residents be in recovery from alcohol or substance abuse, please indicate the type of program you are participating in to work on your recovery.*
Are you an alcoholic? *
Date of your last drink?
Are you a drug addict?*
Date of your last drug use?
Are you currently drinking alcohol and/or using addictive drugs?*
What is your sobriety birth date?
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Are you under the supervision of the Idaho Department of Corrections?*
What is your IDOC number?
IDOC Facility?
Your case manager's name?
Your case manager's phone number?
-
Will you be topping your time?
Your tentative parole date?
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Please indicate which, if any, of the following you are involved with:
If you are involved in any of the above, who do you report to?
Do you have any felony convictions?*
Please list all felony convictions
Have you been convicted of drug manufacturing or distribution?*
Have you been convicted of any violent crimes?*
Please Explain
Are you a sex offender?*
Are you required to register?
Explain
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Reference 1*
Phone1:*
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Reference 2*
Phone2:*
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Reference 3*
Phone3:*
-
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What is your IDOC #?
What is your criminal history? Length/location of incarceration? Release Date? Start with most recent. *
Has your probation/parole ever been revoked?*
Do you have a drug/alcohol problem?*
What are your drug(s) of choice? Name 2.*
Are you currently taking any prescribed medications?*
Have you ever attended or are you currently attending anger management classes?*
If you're not working, you will be expected to actively seek employment a minimum of 10 hours of works skills per week and 10 job searches per week. Do you agree to this?*
How will you pay to live in SHIP's Safe & Sober Housing? Ask your PO if you qualify for transitional funding or call BPA at 800-922-3406. Your funding must be in order before SHIP will allow you into a house. Have a check sent to our office within the week of you release.*
Have you ever been supervised on felony probation/parole?*
Are you currently on court supervision?*
Name and phone number of your probation/parole officer?
What is the date of your last use?
Currently, what are you doing to address your drug/alcohol problem?
Do you have any history of violent behaviors?*
Do you have any source of income? (i.e. Job, SSI, SSD, Food Stamps)*
Monthly Income: $*
What are 2 goals that you want to complete in the next 90 days while residing in SHIP's Safe & Sober Housing? *
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