Avalon Recovery House

Resident Application

Please answer every question. A completed application is required before we can accept an admission — it's how we understand what you need and make sure this house is the right fit for you. Questions marked with an must be answered before the form will submit; please fill in the rest as fully as you can. If any question is hard to put in writing, call us and we'll go through it together.

Confidentiality. Everything you share on this application — including your medications, your criminal history, and any mental health diagnosis — is kept confidential. It is emailed directly to Avalon Recovery House, read only by Anastasia Madden, and used only to consider your application and to care for you safely if you are admitted. We do not sell it, share it, or post it anywhere, and we do not release it to anyone outside the house without your written permission, except where the law requires it. If you would rather answer any question in person or over the phone, that is completely fine — call (804) 585-8514.
01Applicant Information

So we know who you are and how to reach you.

Please give us a phone number, an email, or both.
02Recovery Information

Answered honestly, none of this disqualifies you on its own — it tells us how to support you.

Have you completed detox or residential treatment?
Are you currently in an outpatient treatment program?
Are you on medication-assisted treatment (MAT)?
03Housing Readiness

Living well with others is most of what makes a house work.

Are you willing to follow all house rules and expectations?
Are you willing to take part in house meetings, chores, and recovery activities?
04Employment & Education
Are you currently employed?
05Financial Information
06Legal Information

We ask so we can support you around any obligations — not to screen you out.

Are you a registered sex offender?
07Medical Information

Confidential, shared with house staff only, and used solely to keep you safe.

Are you able to independently perform activities of daily living, including preparing meals, showering/bathing, managing your medications, and maintaining personal hygiene without assistance?
08Community Living
Have you ever been discharged from a recovery residence?
09Support System
10Safety
11Acknowledgment & Signature

Please read and check each one.

Typing your full name below acts as your signature on this application.

Questions first? Call (804) 585-8514.