Sober Living Program

The goal of the Sober Living Program is to promote sobriety among Fairfield County residents with a diagnosed substance abuse program.

Each resident will receive services including but not limited to:

Outreach Services
Case Management Services
Assistance in Obtaining and Coordinating Public Benefits Available
Education regarding life skills, budgeting, maintaining sobriety, etc.

Sober Living Program Referral

"*" indicates required fields

Please attach the following required eligibility documentations:

Documentation of disability (substance use diagnosis) – from a psychiatrist, doctor, counselor, PO, etc.*

Drop files here or

Max. file size: 50 MB.

Housing status (preference given to those who are homeless, i.e. in a shelter or living in a place not meant for human inhabitation, at the time of selection)*

Drop files here or

Max. file size: 50 MB.

Name*

First Last

Date*

Address*

Street Address Address Line 2 City State ZIP / Postal Code

County

Phone*

Email*

I hereby authorize the reciprocal release of information between Lutheran Social Services and the following agency/representative (This consent expires one year from the date it was signed or if the client withdraws the consent):

Referral Source/Agency*

Phone*

Name/Title*

Email*

Client Signature*

Date*

**Program referrals are kept on file for six months from the date received after which time the applicant must reapply.

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Sober Living Program

Sober Living Program Referral

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