Sober Living Assessment and Evaluation Questionnaire
Date of Visit
Name of Sober Living Program
Contact Person in Program
City and Zip Code
Telephone Number with Area Code
Fax with Area Code
Student Directions on Completion:
A printed photograph is required to be attached to this Survey. Photo should show front of house.
Answer questions on a separate piece of paper. Type the question, and type your answer. Complete answers are required.
Be specific when answering each question.
1. What are the admission requirements for the sober living program?
2. What is the cost and form of payment? Is there a security deposit required upon admission?
3. How often are the residents tested?
4. Are the drug tests monitored and random?
5. What are the number of AA/NA/CA meetings required weekly to maintain residence?
6. What are the curfew hours?
7. Do you conduct random room searches?
8. Can you have visitors? If so, can they stay overnight?