Wilson Housing Alliance Recovery Housing Application

Welcome to Wilson Housing Alliance

We are honored to walk alongside you on your journey of recovery. Wilson Housing Alliance was founded by individuals who have personally experienced the challenges of addiction and the transformative power of recovery. Our mission is to provide stable, supportive housing to individuals in recovery while empowering each resident to pursue lasting change with dignity, accountability, and hope.

This application packet outlines everything you need to know about becoming part of our recovery home. Please read it carefully and honestly. Our program is designed to support you but success depends on your willingness to engage, grow, and commit.

We offer structure, support, and a clean and sober living environment rooted in compassion, community, and personal responsibility. Our staff and volunteers are here to help, but your journey is your own.

I have read and understood the "Welcome" section.

Program Structure Overview

Phase 1: Initial Residency

The Initial Residency phase lasts approximately three months, depending on individual progress and completion of required workforce-readiness programming.

During this time, residents are welcomed into a structured and supportive recovery environment where they can stabilize, reconnect with purpose, and begin rebuilding their lives. Residents receive enhanced accountability and staff support as they focus on developing consistent routines, maintaining sobriety, and engaging in meaningful recovery-based activities.

Phase 1 emphasizes structure, cooperation, and readiness for long-term recovery. Residents are expected to:

Complete any required outpatient or treatment programs
Participate in recovery meetings and community activities
Uphold house rules and maintain accountability
Complete the "Recovery Employment Journey – for Job Seekers" course through Recovery and Career Services, a workforce-readiness program that prepares participants for meaningful employment and long-term self-sufficiency.

Monthly Contribution: $800
One-Time Intake Fee: $300 (due at intake)
Increased accountability and staff engagement

Phase 2: Full Residency

After successfully completing Phase 1 requirements, residents may transition to Full Residency. This phase offers increased autonomy and individualized support as residents continue strengthening their recovery foundation and work toward personal goals.

Residents in Phase 2:

Must be employed or enrolled in an accredited educational or training program within 30 days
Serve as positive role models within the household
Contribute to household leadership, mentoring, and accountability
May receive visitors and overnight passes approved on a case-by-case basis to support family restoration and reintegration

Monthly Contribution: $800
Increased autonomy and individualized program support
Ongoing goal setting and mentorship

I have read and understood the Program Structure Overview.

Living in a Wilson Housing Alliance Home

Wilson Housing Alliance is a recovery-based supportive living program.

All residents are expected to uphold our core values: dignity, accountability, mutual respect, and personal growth.

To foster safety, structure, and stability, all residents agree to follow the program's community standards outlined below.

LANDLORD TENANT RULES DO NOT APPLY TO TEMPORARY HOUSING

Please read the following community standards carefully by expanding each section. You will be asked to acknowledge them at the end.

Program Expectations

Productive Engagement

Residents must be employed, volunteering, or participating in an educational or training program within 30 days of entering Phase 2. Staff are available to assist residents in finding suitable opportunities. Idle time is discouraged, as purposeful engagement supports long-term recovery.

Recovery Participation

Residents must attend at least one (1) approved recovery meeting per week, such as AA, NA, or Celebrate Recovery. Participation in formal outpatient treatment may count toward this requirement. Verification may be requested.

Attendance and Absences

Residents must inform staff if they plan to be away for more than 24 hours and receive approval beforehand.
No-call/no-show absences over 48 hours are grounds for dismissal.
DOC-supervised residents must obtain approval for overnight absences directly from their CCO.
Curfew violations or unexplained absences will result in staff and CCO notification.

Cleanliness and Shared Responsibility

Bedrooms: Beds must be made daily; no food in rooms. Shared spaces must remain clean and orderly.
Chores: Assigned weekly or monthly. Residents are responsible for ensuring completion, including finding coverage when absent.
Inspections: Weekly inspections with graded report cards; the house must maintain at least a "B–" rating.

Privacy, Conduct & Substance Use

Search and Accountability

Rooms and belongings may be searched at any time for prohibited items. Staff and DOC personnel may access the property as needed. Cooperation with staff inquiries is mandatory.

Behavior and Conduct

Treat others with respect; no romantic or sexual relationships between residents.
No pets or animals of any kind (including service or emotional support animals).
No guests or visitors unless pre-approved in writing by staff.
No individuals under 18 allowed on-site without formal approval.
No outside romantic partners allowed on the property.

Substance Use Policy

Wilson Housing Alliance maintains a zero-tolerance policy for drugs, alcohol, or marijuana (including prescribed or recreational use).

Baseline and random testing is conducted.
Refusal, failure, or tampering will result in immediate discharge.
All medications must be disclosed and approved.
Providing substances or paraphernalia to others will result in permanent removal.

Property, Safety & Community Standards

Personal Property and Finances

Do not lend or borrow money.
Avoid bringing valuables over $50 in value.
Abandoned items (after 10 days) may be donated or discarded.
Resident vehicles must be legal, insured, and operable.
Wilson Housing Alliance is not responsible for lost or damaged property.

Safety and House Behavior

Smoking and vaping are allowed only in designated outdoor areas — never indoors or on porches.

Theft of any kind, including food or personal items, results in immediate termination.
No open flames (candles, incense, etc.).
Property damage may result in shared financial liability.
Door codes are confidential — sharing them may lead to dismissal.

Curfew:

Sunday–Thursday: 10:00 PM
Friday–Saturday: 12:00 AM

All exceptions require staff approval. DOC-supervised residents must comply with additional monitoring.

Technology Use

Computers and printers (if provided) must stay in common areas. Personal device use should never interfere with others or disrupt the peace of the household.

Community Conduct

Residents represent Wilson Housing Alliance within the community. Courtesy and respect toward neighbors are expected at all times.

Legal-Involvement Policy

Residents referred through court, diversion, or legal programs are reviewed individually if legal issues arise during residency.

Incarceration or program violations may result in bed forfeiture. Decisions regarding continued placement or reentry are made by Wilson Housing Alliance in consultation with CCOs, treatment providers, or legal representatives.

Wilson Housing Alliance operates under RCW 59.18.550 as a drug- and alcohol-free housing program committed to supporting recovery through structure and accountability.

Summary

Wilson Housing Alliance provides more than housing — it offers a structured path to rebuild lives through community, accountability, and purpose.

Our two-phase model balances structure with independence, helping residents move from stabilization to self-sufficiency with dignity and support.

I have read and agree to follow all community standards and program expectations listed above.

Client Intake Information

Name *

Date *

Birth Date *

Age

Phone *

Email *

Agency Affiliation (if any)

Veteran *

Yes

No

ID Card? *

Yes

No

SSN Card? *

Yes

No

Financial, Health & Legal History

Income (Check all that apply) *

Working

DOC Housing Voucher

SSI

SSDI

Other

Healthcare (Check all that apply)

Medicaid

Medicare

Both

Other

Barriers to Housing (Check all that apply)

Eviction

Debt

Other

Please describe any past or present mental health history. * Please list the mental health services you currently receive. *

Please describe your history of substance use or addiction. * Please list the substance use services you currently receive. *

Incarceration or Arrest History (Any pending charges?)

Work History & Plans

Are you currently working or actively looking for work? *

Yes

No

Type of work (or desired field)

Work History (Briefly describe your past 2-3 jobs)

Highest Education Level

Do you plan to enroll in school or job training? *

Yes

No

Type of training or program

What should we know about you to assist you? Please feel free to write below.

Emergency Contacts / Family or Friends

Resident Signature

By signing below, I affirm that all information provided in this application is true and accurate to the best of my knowledge.

Signature *

Printed Name *

Date *

Terms & Agreements

Involuntary Termination of Residency

Please initial next to each item to acknowledge you understand these are grounds for immediate termination.

Client Terms and Conditions

Please initial next to each item to acknowledge your agreement.

Agreement Signature

Signature *

Print Name *

Date *

Authorization for Release of Information

Click to Read Full ROI Instructions

ROI's must be completed in blue or black pen to be processed. All writing must be legible for records to be released. The ROI form allows Wilson Housing Alliance to communicate with providers or parties involved in your treatment, legal case, or recovery plan. This information may be necessary to confirm eligibility, monitor progress, or coordinate services. You have the right to limit what information is released and to whom. Signing the ROI is voluntary but may impact our ability to assist you if not completed.

Applicant's Information: On the top of the ROI, it will ask for applicant's name and Date of Birth (DOB). Applicants name must include both first and last name for the request to be fulfilled. If the applicant has a previous last name, you will need to complete a separate, independent ROI form to request the records for each name.

Person/Agency Receiving Information: This section must include the complete name of the person we will be releasing records to. If the person requesting the records is the same person we will be releasing to, we will still need the complete name. All ROI's must include the complete mailing address in this section for release. We use this for verification and an alternative method of release in case we are unable to fax or email. If you would like records emailed or faxed, the email address will need to be provided in this section. Please make sure that they are clear and legible. If there is a preferred method you would like the records to be released, please circle the preferred method of release in this section. We will attempt to accommodate all requests; however, may be denied due to fax and email limitations. If we are unable to release by fax/email, we would then mail the records out or prepare for pick-up if the option is checked off on the ROI form.

Information to be disclosed: This section indicates which specific records you are authorizing for release. If you are still unsure which one to check off, please feel free to use the "Other" option and write which records you are authorizing for release.

Dates of Records: ROI's can be used for extended release for up to a year, if there are no changes. If you would like to use this option, you will need to complete the section that states, "I revoke this authorization" and either use the date that is 1 year from the date you are signing the ROI form or you may check off one of the other options listed in this section.

Name

Date

Person/Agency authorized to make the disclosure:

Wilson Housing Alliance
4920 Evergreen Way South #1106
Everett WA 98203

Person/Agency Receiving the Information:

Name

Phone #

Address

E-mail

Pick Up

Fax #

Dates of Records:

From:

to:

OR if no dates,

years will be released.

Check here if each of the above parties may disclose your information with the other party. The above information may include records of drug abuse, alcoholism, medical history, criminal history, residency history.

Purpose for Disclosure:

I understand I may revoke this authorization at any time by writing to Wilson Housing Alliance. The revocation will be effective except to the extent that action based on this authorization has already been taken. Wilson Housing Alliance may not condition eligibility for housing on whether the consumer signs the authorization. The information used or disclosed by this authorization may be at risk for re-disclosure by the recipient and no longer protected by federal privacy laws.

This consent will expire (Check all that apply):

Upon denial of application for residency

Upon termination of residency

Signature of Applicant

Date of Signature

Notice: Alcohol and drug abuse patient records are protected by Federal confidentiality regulations (42 CFR part 2). The Federal regulations prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR part 2. A general authorization for the release medical or other information is NOT sufficient for this purpose. The Federal regulations restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient. Communicable disease related information, pursuant to this release, cannot be re-disclosed without specific authorization. (A.R.S. 36-664.H)

HIPAA & Final Agreement

Authority for Release of PHI Under HIPAA

This section shall be interpreted to specifically allow for the release to Wilson Housing Alliance (WHA) of any information subject to the provision of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). 42 U.S.C. 1320d and CFR 160-164.

The Principal authorizes any physician, health care professional, dentist, health plan, hospital, clinic, laboratory, pharmacy or other covered health care provider, any insurance company and the Medical Information Bureau Inc. or other health care clearinghouse that has Principal for such services, to give, disclose, and release to the WHA, without restriction, all of Principal's individually identifiable health information (as defined in HIPAA), financial and billing records, and medical records regarding any past, present or future treatment of HIV/AIDSs, sexually transmitted diseases, mental illness, and drug or alcohol abuse. The Principal understands that once the foregoing information is disclosed, it may be redisclosed by the WHA and the information may not be protected by federal or state privacy laws or regulations. This authority given to the WHA shall supersede any prior agreement that the Principal may have made with Principal's health care providers to restrict access to or disclose of Principal's individually identifiable health information. This authority given to the WHA has no expiration date and shall terminate only in the event that the Principal revokes this authority in writing and delivers it to Principal's health care provider. The Principal hereby waives the physician-patient privilege as to all communications between any physician (or other health care provider) and the Principal and Principal to the extent necessary to permit any such physician (or other health care provider) to disclose to the WHA all such individually identifiable health information.

Principal Signature *

Principal Print Name *

Date *

Final Agreement

By signing below, I acknowledge that I have read, understood, and agree to follow all rules, policies, and procedures outlined in the Wilson Housing Alliance Resident Application Packet. I understand that failure to comply may result in disciplinary action, including possible termination of residency.

Resident Signature *

Resident Name (Printed) *

Date *

Review & Submit Your Application

You're almost done! Please click the "Preview PDF" button to review your completed application. Ensure all information is correct before submitting.

Resident Application

Welcome to Wilson Housing Alliance

Option 1: Complete Online (Recommended)

Option 2: Download Blank Form

Download Started

Recovery Housing Application

Welcome to Wilson Housing Alliance

Program Structure Overview

Phase 1: Initial Residency

Phase 2: Full Residency

Living in a Wilson Housing Alliance Home

Productive Engagement

Recovery Participation

Attendance and Absences

Cleanliness and Shared Responsibility

Search and Accountability

Behavior and Conduct

Substance Use Policy

Personal Property and Finances

Safety and House Behavior

Technology Use

Community Conduct

Legal-Involvement Policy

Summary

Client Intake Information

Financial, Health & Legal History

Work History & Plans

Emergency Contacts / Family or Friends

Resident Signature

Terms & Agreements

Involuntary Termination of Residency

Client Terms and Conditions

Agreement Signature

Authorization for Release of Information

HIPAA & Final Agreement

Authority for Release of PHI Under HIPAA

Final Agreement

Review & Submit Your Application

Thank You for Your Submission!