Apply | blazinghoperanch

RESIDENT APPLICATION

First Name

Last Name

Age

Are you currently in a program?

Yes

If yes, which program are you in?

Where do you currently reside?

How long have you been out of the life/clean?

What other progams have you been in? Did you complete them? What was helpful/unhelpful?

What is your religious preference, if any?

What do you do when something doesn't work out the way you wanted?

How do you typically react to conflict? Is there anything you'd want to do differently?

How would you describe your overall medical health? What medical conditions do you currently have (including STDs)?

Tell me about your history of substance and alcohol use/abuse.

Tell me about your relationship with food. Do you love it, hate it?

What does self-care mean to you, and what do you do to take care of yourself?

What is your history with suicidal thoughts or attempts?

What is your history, if any, with counseling? What was helpful/unhelpful?

Describe the healthiest relationship you currently have.

Describe the relationship that you're most broken in, and why.

What do you like to do for fun?

What do you hope to get out of the transitional program at Blazing Hope Ranch?

Thank you, your application has been sent.