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					                            Second Chance of Asheville
                                   Application
                           PO Box 1643, Arden, NC 28704
                      Phone: (828) 777-2815 Fax: (828) 676-0151



Second Chance of Asheville is a Recovery House for Men. It is designed to provide a safe place
for those interested in continuing their recovery process after treatment or incarceration, and dai-
ly involvement with an approved self-help group is mandatory. Guests may stay for a year and
up to 18 months under approved circumstances.
Application requires completion of an application form, an autobiography, a signed acceptance
of the rules and a face-to-face interview. No one will be admitted without the application process
completed in its entirety. All the necessary forms are included in this packet and you may copy
them as needed. We will come to your facility for the interview.
All those wishing to stay at the SCA are considered guests and must understand that if the rules
are not followed they may be asked to leave at any time. All guests are expected to begin work-
ing immediately and have a fulltime job within two weeks of arrival, or have an acceptable
means of income if disabled. The SCA is located on the bus line. Labor Ready and Labor Finders
(temporary work agencies) are acceptable means of employment, although guests are not limited
to these organizations.
Those wishing to stay at the SCA must pay a $50 non-refundable fee which will cover paper-
work, criminal background check and other related expenses. This fee is due at entry and is non-
refundable even if the person does not stay the night. Guests are also expected to pay a $100 de-
posit which will be refunded if they leave in good standing.* All guests must pay $115.00 per
week for lodging plus $5 for supplies used in common by everyone to stay at the SCA( A total
of $120.00 per week). We understand that those coming from treatment may not have the up
front money necessary, so guests must at a minimum find employment that pays daily; weekly
fees will be prorated until they are paid up.
The SCA will not accept anyone with a criminal history of violence. If guests are on prescribed
medication, they must report it to the staff and show proof of how the medication is to be taken,
but staff will not be responsible for securing their medication or seeing that it is taken as pre-
scribed. Anyone suspected of misusing their medications may be asked to leave. The SCA will
also not accept anyone with a co-occurring mental diagnosis that may not be conducive to a re-
covery house atmosphere. All applicants must be able to work, or have an acceptable outside oc-
cupation if disabled.
Guests must be willing to submit to random urine drug screens and, random room inspections. It
is the intention of the SCA to run a “tight ship”. If you have individuals that you think are appro-
priate please contact us
*Leaving in Good Standing Meaning, Gave at least a Two week Notice, Clean Lodging
Area, Remove all Trash, Put Linen in Washing Area, Pay all Lodging Fees, and Fines.




                                            Page 1 of 9
                           Second Chance of Asheville
                                  Application
                          PO Box 1643, Arden, NC 28704
                     Phone: (828) 777-2815 Fax: (828) 676-0151
Admissions Procedure Checklist
Application requires completion of an application form, an autobiography, signed accep-
tance of the rules and a face to face interview. No one will be admitted without the applica-
tion process completed in its entirety. All the forms necessary are included in this packet.
We will come to your facility for the interview.
Fill out and initial admission forms.
    Autobiography
    Initial page 1 and sign page 2 of the phase system
    Initial pages 1 and 2 and sign page 3 of the rules and contract
    Complete the application form
    Send pages 4 – 12 and your Autobiography to us (preferably by fax)
                                          Autobiography
The SCA requires an autobiography in addition to an application and interview so that we can
better determine if you are right for our program and we are right for you. Having this informa-
tion in your own words will help us make this determination. We do not expect you to write vo-
lumes, but we do expect that you put thought into what you write. The following are some sug-
gestions for what you might include in your autobiography. You are not limited to these sugges-
tions.



   1. What was your life like growing up?
   2. What was it like in your family? Was your family loving and supportive or was there vi-
       olence, addiction?
   3. What was school like for you? Did you enjoy school, did you graduate, and did you make
       good grades? Do you want to continue your education?
   4. What were your friends like? Do you have lots of friends or are you a loner?
   5. What is the history of your drug use? Have you been in treatment before? Have you been
       involved with a 12 Step program? What are you willing to do to change your life?
   6. What is your work history? Are you doing what you want? Have you ever been fired
       from a job, why or why not?
   7. Have you ever been arrested? Why? Do you have any charges pending? What? Have you
       spent time in jail or prison? Why, how long?
   8. What is your family like now? Are you married? Do you have children? How can you
       improve your family life?
   9. What are your dreams? Is your life turning out the way you want? What can you do to
       make your life better? How can you make your dreams come true?
   10. How do you think the SCA can help you? What contributions can you make to the SCA?




                                          Page 2 of 9
                            Second Chance of Asheville
                                   Application
                            PO Box 1643, Arden, NC 28704
                       Phone: (828) 777-2815 Fax: (828) 676-0151
                                    Application for Admission

1. Name:

2. Address:



3. Age:

4. Married  Single  Separated  Divorced 

   Wife/Husband or Significant Other’s name:

5. Emergency contact name and number:

6. Children: Yes  No 

   Names of Children                                   Ages        Custody




7. Please list other significant relationships, past or present:




8. Employment Skills:




9. Are you currently employed? Yes  No  If yes, where?



                                             Page 3 of 9
                            Second Chance of Asheville
                                   Application
                           PO Box 1643, Arden, NC 28704
                      Phone: (828) 777-2815 Fax: (828) 676-0151
10. Physical and Mental Health (please describe any problems you may have):




11. Are you taking any medications? Yes  No  If yes, what?




12. Physician’s name and address:



13. Alcohol and other Drug use (please list all, including nicotine):

   Drug                                       Age of first use               Date of last use




14. Treatment history (location, dates, diagnoses)(If current, state expected release date):




                                            Page 4 of 9
                            Second Chance of Asheville
                                   Application
                           PO Box 1643, Arden, NC 28704
                      Phone: (828) 777-2815 Fax: (828) 676-0151
15. 12 Step Involvement(s): AA  NA  Alanon  Naranon  Other 

   If other, please describe:



16. Sponsor: Yes  No 

17. Family involvement in treatment: Yes  No  If no, why not?




18. Family history and history of family alcohol or other drug use:




19. Criminal history: Yes  No  If yes, please list all charges, convictions and dates:




20. Do you have any outstanding legal charges? Yes  No  If yes, please explain:




21. How would you describe your commitment to recovery?




                                           Page 5 of 9
                           Second Chance of Asheville
                                  Application
                            PO Box 1643, Arden, NC 28704
                       Phone: (828) 777-2815 Fax: (828) 676-0151
I swear that all the information in this application is true to the best of my knowledge. I
further understand that completing this application does not guarantee admission to SCA
I understand that if any part of the information in this application is found to be delibe-
rately misleading or not true, it may result in my dismissal from the SCA Recovery Resi-
dence.
I understand that the information in this application will be kept confidential.




Client signature                                                 Date


                                    For Office Use Only
General Impressions:




Approved: Yes  No  If no, explain




                                         Page 6 of 9
                                         Second Chance of Asheville
                                                Application
                                      PO Box 1643, Arden, NC 28704
                                 Phone: (828) 777-2815 Fax: (828) 676-0151
                                                                Phase System

The following Phase System was developed to help new guests at the SCA gain a sense of responsibility as they begin their recovery. All new
guests will begin in Phase One unless the SCA staff believes that they are far enough along in their recovery to warrant a higher level of respon-
sibility. No exceptions will be made regarding these phases as the SCA philosophy maintains that responsibility is learned slowly and privileges
are the rewards for learning to be responsible.
Phase One Requirements

1.   Must have verified attendance at an approved self help meeting daily
2.   Must verify the acquisition of a temporary sponsor within 2 weeks of arrival
3.   Must verify the acquisition of the phone numbers of at least 7 recovering men per
     week.
4.   No overnight passes
5.   Must sign the roster when coming in and out
6.   Must be in by 7pm unless attending an approved self help meeting
7.   Must be accompanied by a SCA guest in Phase 2 or 3 or by an approved member of the recovering community when away from the SCA
     and not at work.
8.   Must be in by the 7pm curfew, 10pm on nights attending meetings.
9.   Must stay in this phase a minimum of 2 months, be current with all fees and fines, have abided by all rules, completed all chores, met all
     Phase One requirements and be approved by staff to move to Phase Two.
10. Must submit to random urine drug screens.
Phase Two Requirements and Privileges

1.   Must verify attendance at an approved self help meeting a minimum of 5 times per week.
2.   Must verify constant contact with temporary sponsor; be actively, seriously working the program and working seriously on finding a per-
     manent sponsor.
3.   Must be in by 11pm curfew Sunday through Thursday and lam on Friday and Saturday.
4.   May obtain an overnight pass when approved by the staff and requested 24 hours in advance and must submit to a urine drug screen upon
     return.
5.   May leave the SCA without being accompanied by another guest or member of the recovering community.
6.   Must stay in this phase a minimum of 2 months, be current with all fees and fines,
     have abided by all rules, completed all chores, met all Phase Two requirements and be approved by staff to move to Phase Three.
Phase Three Requirements and Privileges

1.   Must attend a minimum of 3 approved self help meetings per week.
2.   Must have obtained a permanent sponsor and be actively, seriously working a program, have a home group and actively involved in service
     work.
3.   Must be in by 11pm weekday curfew and by 2 am on weekends.
4.   Must give 8 hours notice for overnight stays, may stay out two consecutive nights and up to three non-consecutive nights per week and must
     be willing to submit to a urine drug screen upon return to the SCA.
5.   Will be allowed a television in the room.
6.   Continue to complete all chores as assigned.
7.   Be an example to new guests regarding a recovering lifestyle and assist them in settling into their routine at the SCA.



Guest Signature                                                                            Date



Witness Signature




                                                                 Page 7 of 9
                                  Second Chance of Asheville
                                         Application
                                PO Box 1643, Arden, NC 28704
                           Phone: (828) 777-2815 Fax: (828) 676-0151
                                                  Rules and Contract


1.   Although I am provided with lodging at the SCA, I UNDERSTAND THAT I AM A GUEST and may be
     asked to leave immediately if I do not follow the rules.

2.   ABSOLUTELY NO DRINKING OR DRUG USE IS PERMITTED at the SCA or anywhere else during my
     stay at the SCA at any time. Failure to abide by this rule may result in immediate dismissal. I understand that I
     must submit to random drug screens at the discretion of the SCA staff

3.   There is ABSOLUTELY NO SMOKING INSIDE THE SCA and I understand that I may smoke in designat-
     ed areas only.

4.   I understand that I am responsible for supplying my own food. I also understand that I will not eat or tamper
     with food that does not belong to me. I understand that eating someone else’s food without permission is
     STEALING.

5.   When using the kitchen I will clean up after myself. Eating and drinking are allowed in the kitchen and dining
     room only, unless by special permission.

6.   Sleeping is allowed in beds only. I understand that I will not sleep on sofas or chairs in the common area.

7.   I will keep my things in their proper place whether bedroom or bathroom. I understand that the SCA is NOT
     RESPONSIBLE FOR LOST OR STOLEN ITEMS.

8.   I will keep my room clean and make up my bed each morning. I will submit to random room checks.

9.   I will turn off all appliances and lights when not in use.

10. I will be considerate of others when using the bathroom. I will not stay in the bathroom for an inordinately long
     period of time and I will make sure the bathroom is clean when I leave, including cleaning out the sink and tub.
     I will take my towels and personal items back to the room with me.

11. I will not lend or borrow money nor will I engage in buying or selling items from other residents.
12. I understand that FIGHTING OR AGGRESSIVE BEHAVIOR TOWARD STAFF OR OTHER
     RESIDENTS WILL NOT BE TOLERATED and may lead to my immediate dismissal. I understand that I
     will be responsible for and will pay for any damages that I incur.

13. ABSOLUTELY NO WEAPONS ARE ALLOWED ON THE SCA PROPERTY. If I am found to have a
     weapon, I understand that I may be immediately dismissed.

14. I understand that I must immediately seek employment and must have a regular, fulltime job within two weeks
     of my arrival at the SCA. I must begin paying rent the first week after my arrival. If I am fired from a job, I will
     immediately tell the staff. If I am thinking about quitting a job, I will discuss it with the staff first.

15. I understand that any criminal charges received while a staying at the SCA are grounds for immediate dismissal.
16. I understand that STEALING WILL NOT BE TOLERATED and may be grounds for immediate dismissal.
17. I understand that it is my responsibility to secure all my valuable items and that the SCA IS NOT
     RESPONSIBLE FOR ANY LOST OF STOLEN ITEMS.

18. I understand that the SCA will be a safe place for me to work on my recovery and as a result, I agree to submit
     to random drug screens and random room inspections.

19. I understand that gambling can be a form of addiction and I will not engage in this behavior while staying at the
     SCA.

                                                      Page 8 of 9
                                 Second Chance of Asheville
                                        Application
                               PO Box 1643, Arden, NC 28704
                          Phone: (828) 777-2815 Fax: (828) 676-0151
20. House computers are not to be used to access inappropriate or sexually-explicit websites, and I agree not to use
    computers for this reason while at the SCA. THIS RULE IS STRINGENTLY ENFORCED!

21. I agree not to enter another guest’s room unless that person is with me and invites me in. ABSOLUTELY NO
    ONE NOT STAYING AT THE SCA IS EVER PERMITTED IN MY ROOM. No family members or other
    visitors are allowed on the SCA property without prior approval.

22. ABSOLUTELY NO LOITERING IN THE FRONT OF THE SCA BUILDING OR TALKING TO THE
    NEIGHBORS ACROSS THE STREET.

23. I understand that I must be in by my curfew unless I am working or if I have special permission from staff.
    Doors will be locked at curfew and no one will be admitted into the house unless appropriate arrangements have
    been made. Those in Phase One must sign in and out on the roster.

24. Lights, television, radios and stereo equipment must be turned down at 11pm. I understand that I may use per-
    sonal audio equipment with headphones after that time and as long as I am assured that no one is bothered. Tel-
    evisions may be allowed in my room when I have reached Phase III.

25. I have been given information on the SCA’s Phase System which applies to all those staying on the property. I
    agree to abide strictly by these requirements and privileges. I agree to abide by my curfew.

26. I understand that no telephone calls are to be made or received between the hours of 11pm and 5am unless it is
    an emergency.

27. I agree to pay my weekly fees promptly. I understand that lack of payment may result in my dismissal. Fees
    consist of $115 per week to receive guest lodging and $5 per week (as needed) for the kitty which will provide
    petty cash, emergency funds and household items such as toilet paper and cleaning supplies. I understand that
    my $50 processing fee in non-refundable under any circumstances.

28. I understand that my attendance at weekly House meetings is MANDATORY AND THAT THERE ARE NO
    EXCEPTIONS.

29. Due to the danger of communicable diseases such as HIV and Hepatitis C, I understand that I WILL NEVER
    LEND OR USE SOMEONE ELSE’S PERSONAL CARE PRODUCTS such as combs, hair clippers, nail
    clippers, toothbrushes or razors etc.

I understand, as indicated by my voluntarily signing this agreement, that I am considered a guest of the SCA and I
may be allowed to remain on the property as a guest, receiving overnight lodging through the election and evalua-
tion of the SCA staff. The decision to provide overnight lodging as a guest will be at the sole discretion of the SCA
staff: Any failure to comply with the program rules is grounds for my immediate dismissal and termination of this
agreement. In addition, staff of the SCA may terminate this agreement at their sole discretion for any reason what-
soever, with or without advance notice.
I UNDERSTAND THAT I AM NOT A TENANT OF THE SCA. IF THIS AGREEMENT IS
TERMINATED, MY GUEST STATUS WILL ALSO BE TERMINATED. I UNDERSTAND THAT I WILL
BE TRESPASSING IF I REMAIN ON THE PREMISES AND THAT I MAY BE REMOVED FROM THE
PROPERTY AS PROVIDED BY LAW.
The failure of the SCA to insist on strict performance of any of the terms of this agreement will not be construed as a
waiver of the future right to insist on full performance and strict compliance to all of the terns in this agreement.
This contract sets forth the entire agreement between both parties and cannot be modified except by further written
agreement, signed by both parties.


Guest Signature                                                          Date


Witness Signature

                                                    Page 9 of 9

				
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