Resident Application

Take the first step toward recovery. All information provided is confidential and will be used solely for admission purposes.

NARR Certified ResidenceCertification application pending

Location

15 Jessup St, Stamford CT 06902

Call Us

(203) 247-6870

info@enomaycare.com

1Personal Information

Full Name *

Date of Birth *

Email Address *

Phone Number *

Current Address

Photo (Optional)

2Emergency Contact

Contact Name

Contact Phone

Relationship

3Recovery Information

I have completed previous treatment or rehabilitation program

Date of Last Substance Use

Why are you seeking sober living at this time?

4Employment & Financial

Employment Status

Source of Income

5Medical & Legal Information

I am currently taking prescription medications

I have medical conditions we should be aware of

I have a criminal history to disclose

6Supporting Documents

Optional but Recommended: Upload supporting documents to help expedite your application review.

Government-Issued ID (Driver's License, Passport, etc.)

Proof of Income (Pay stub, Bank statement, etc.)

Additional Documents (Optional)

7Housing Preference

Room Preference

Preferred Location

Application Fee: $40.00

A non-refundable application fee of $40.00 is required to process your application. You'll be able to pay securely with credit/debit card, Apple Pay, or Google Pay.

Secure Payment: Your payment information is encrypted and processed securely.

By continuing, you agree to our terms and conditions. All information is kept confidential. A $40.00 application fee will be charged.