Online Application

Take the next step — apply today.

Whether you're applying for yourself, a loved one, or a client, this form takes about five minutes. Everything is confidential. A member of our team will reach out shortly to complete the assessment.

5 minutes to complete

Reviewed within 1 business day

Confidential

Step 1

Who is applying?

This helps us route your application to the right team member.

Step 2

Applicant information

Tell us about the man who would be moving in.

Full name *

Email *

Phone *

Date of birth

City

State

Step 3

Recovery background

Everything here is confidential and only used to help us support the applicant.

Primary substance(s)

Sobriety date (if any)

Applicant is a U.S. veteranOn probation or paroleCurrently incarcerated

Step 4

Life & health details

Helps us plan the right support from day one.

Employment status

Medical needs (optional)

Mental health needs (optional)

Current medications (optional)

Step 5

Emergency contact & move-in

Emergency contact name

Emergency contact phone

Relationship

Desired move-in date

Anything else we should know?

I understand that New Pathway Living is a drug-free residence and that applicants must be 18+, willing to follow house rules, participate in recovery support, respect fellow residents, and engage in employment or productive daily activity. I confirm the information above is accurate.

Prefer to talk? Call us