Online Application
  Submitting this application is only the first step in the process.
 After submitting application please call 612-440-3299 to schedule a interview.
Please only call once a day. 
If you are in a place where its hard to get call backs call after 4:00 pm if at all possible.
Please note the type of housing we have.
MPLS locations are shared rooms (bunk beds)
Richfield - shared and single rooms - (based on seniority)
Bloomington - designed to bridge the gap from structured sober housing to living on your own. Must have job and close to 1 year sober
There is no damage deposit required at this time for any of the houses.
Eazyliven Men's sober living DOES NOT accept Registered Sex Offenders.






First Name:











Last Name:











Address Street 1:











Address Street 2:











City:











Zip Code:




(5 digits)






State:











Phone:











Email:





            Date of Birth:
           






Emergency Contact:











Relationship:












Emergency Contact Number?:





             Have you ever stayed at EazyLiven before?:            
            If Yes when?:            
             Are you currently attending NuWay IOP?:            
            If yes, What location?:            
             If yes, Are you in another Soberhouse?:            






Are you referred to the Nuway IOP program?:





            If yes, What location?:            






Date Housing Needed:





            House locations listed bellow, please select preferred location, you can select more then one.
             
             South MPLS, Oakland house - 27th and Oakland:              
             South MPLS, 1st ave house - 40th and 1st ave:              
             Richfield - 75th and Portland:              
            Bloomington - Extended Sober housing - must be employed and close to 1 Year sober:              






Are you a alcoholic or drug addict?:











What is your drug of Choice?:











Last date of use?:











Are you on Suboxone?:











Are you on Methadone?:











If yes, What clinic?:











Are you currently in treatment?:











If yes, Where?:











Counselor name:











Counselor contact info:











Do you have a Mental Health diagnosis?:











If yes, What is your diagnosis?:











Medication List













Medication Name:











What does this treat?:











Medication Name:











What does this treat?:











Medication Name:











What does this treat?:











Medication Name:











What does this treat?:











Medication Name:











What does this treat?:











How are you planning on paying rent?:











If employed, Where at?:











List any convictions:











Are you on probation or parole?:











If yes, List PO's name:











PO's contact into:











Are you on a commitment?:











If yes, Workers name.:











Workers contact info:











By initialing the below questions, I understand to meet the following all rules and exceptions, if accepted for residency into Eazyliven Men's sober Living.













I will agree to sign releases of information to all the above noted individuals. :











I will stay medication compliant at all times and notify Eazyliven of nay changes:











If applicable, I agree to pay my monthly rent on the 1st of every month.:











I agree to remain clean and sober at all times:











I agree to keep Eazyliven Men's sober housing free from alcohol / illegal drugs at all times:











By accepting residence at Eazyliven I will follow all rules and regulations.:











In accepting these terms, I understand that I exclude myself from the normal due process afforded by local landlord tenant laws.:











By submitting this application, I certify that All information I have provided to Eazyliven Men’s Sober Living is true and correct. I have read all material on this application form including the limitations above. I have answered each question honestly and want to achieve a life of sobriety, free from alcohol and/or drug addiction.:







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