Application

Applicants must provide and agree to the following:

1. Photocopy of Driver’s License or other form of photo ID

2. The Signed Rules Form

3. Random Drug and Alcohol Testing

4. Medical Authorization (Allowing the outreach to verify doctor’s  appointments,  prescriptions, and diagnoses.)

5. Contact Information for Sponsor

6. Work with our Life Coach and or Mentor to create a vision for your life in recovery and establish goals to achieve that vision.

7. Any directive from a representative of the Pellow Outreach that he or she believes to be necessary to help you succeed in your desire to live a satisfying life in recovery, free from addictive substances or behaviors.

8. 30-day notice required before departure.

 
 

Online Form

Legal Name *
Legal Name
Mailing Address
Mailing Address
Have you ever been charged with or pled guilty to a felony or misdemeanor? *
Do you currently have a sponsor? *
If you answered no, have you ever had a sponsor in the past?
Have you ever worked a 12 step program? *
Have you ever participated in any inpatient treatment? *
Have you ever been emotionally or sexually abused? *
Have you ever been physically abused? *
Were charges filed? *
If accepted, the applicant agrees that the location of the mentoring house not be divulged to the abuser, or others known by the abuser.
(Must be possible, even if you don’t understand how to do it)
1. No use of drugs or alcohol. Residents agree to random drug and alcohol testing. The Pellow House is a tobacco-free facility. No tobacco products or vaping allowed on the premises. 2. No pornography or gambling. 3. Romantic, flirtatious, or sexual non-marital relationships are not allowed while at the Pellow House. 4. No physical or, verbal abuse or threat of violence or intimidation. 5. Resident is required to check in with mentor between 12:00 noon and 3:00 p.m. every day. 6. Curfew is 8:00 PM for any new resident. For all others, curfew is 10:00 PM unless extended by mentor. 7. All residents are required to have employment. Two meetings a day are required until employment is obtained. Meetings are available in the metro area from 5:00 a.m. to 8:00 p.m. 8. Spirituality is a must in recovery. Attending weekly and being active in a Christian church of your choice is required. 9. All residents agree to a minimum of 4 hours per month of community service 10. Resident will attend the Pellow House Schedule, No Excuses AA, Celebrate Recovery, PO men’s mentoring, or other meetings as directed by mentor. 11. Residents agree that no over the counter drugs will be utilized without the approval of the mentor. 12. No guests are allowed at the Pellow House unless approved by the mentor. Approved guest are restricted to the common areas of the house and are the responsibility of the occupant. 13. Resident is financially responsible for any damage he or their guest have caused to the facility or its contents. 14. Resident will respect the privacy and property of other residents and neighbors. 15. No parking in front of neighbors homes. 16. Residents are expected to practice daily hygiene and good grooming habits. Sideburns, mustaches and beards should be neatly trimmed. Piercings are not permitted. 17. Language should be polite and lacking in vulgarity. 18. Housekeeping Responsibilities: Housekeeping/Yard chores will be assigned weekly. Personal area: Bed made, clothes properly put away, and bathroom left clean at all times. Common areas: Are to be kept clean and neat at all times, with any items, including those used for eating, cooking, crafts, housecleaning, etc, being cleaned and put away immediately following use. 19. Overnight privileges may be granted through Joe Pellow only if resident is actively working, has obtained a sponsor, and completed Step 1 of either the AA or Celebrate Recovery programs. I have read and agreed to follow all of the Pellow House rules. *