Dignity Restored Resident Management System

People • Purpose • Progress

Transitional Housing Application

Application & Screening Authorization
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Important notice: Completing this application does not guarantee acceptance or placement. Admission includes application review, interview, verification and screening and depends on eligibility, available space, safety/program fit and willingness to follow program requirements. Applicants may request a reasonable accommodation related to a disability.
* Required field. Please complete all required items before submitting the application. If a required item is missing, the form will stop and take you to the first item that needs attention.

Application Source

1. Applicant Information

Documents Available
Identification Status
Identification upload is optional. If you have identification available, you may upload a copy to assist with application review. Uploading identification is not required to submit an application. Dignity Restored can assist applicants who need help obtaining identification.

2. Current Housing Situation

3. Employment, Income & Benefits

Benefits / Other Income
Employment / stability support requested
Resources / services you would like help with

4. Legal & Supervision Information

A history of incarceration does not automatically disqualify an applicant. Legal information is used for eligibility, placement, safety planning and supervision coordination.

5. Health, Medication & Accessibility

Health / counseling services you would like help accessing

6. Substance Use & Recovery Support

Recovery / stability support requested

7. Transportation, Vehicle & Emergency Contact

Transportation Used

8. Personal Goals

9–10. Financial & Important House-Rule Understanding

Standard monthly bed fee: $875.00. Standard deposit: $875.00, separate from the monthly bed fee. Authorized Directors may approve different rates, proration, sponsorship, payment arrangements or full/partial waivers. Curfew is 11:00 PM every night. No unauthorized guests. Drugs and alcohol may not be possessed or used on the property. Residents use sign-in/out, complete household responsibilities, attend required meetings and work toward an approved Stability Plan.
Acknowledgments

11–12. Screening Authorization & Release of Information

Authorization
People / Agencies Dignity Restored May Contact

13. Applicant Certification & Electronic Signature

Online status access: Create a 6-digit PIN. After submission, use your DRRMS application number and this PIN to check your application status. Keep your PIN private.
Certification
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