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Transformational Recovery Residences

Resident Screening Application

Recovery Housing

Weekly/Monthly residential fees will be applied.  Grants, contributions and scholarship funds may be applied for residents who are accepted into the residential program, subject to availability and the donor's requirements.  

With more than 30 years of experience in residential community programs, Dismas House of Kansas City offers transformational housing for residents who are committed to their personal recovery and want a chance to rebuild their lives. 

Residents will be a part of a multi-disciplinary team of staff and volunteers who will work to support each resident in identifying and accomplishing goals for recovering and re-establishing themselves in freedom and purpose.   These are quality and safe environments with three to five residents in each home,  where residents can stay up six months or longer by maintaining eligibility and complying with the program and residence rules.  

Residents must:

· Be at least 18 years of age and legal residents of the United States, and have valid photo identification. 

· Be actively seeking recovery from a substance use disorder;

· Demonstrate a willingness to comply with the program and house rules;

* Additional requirements and criteria may apply. Due to space limitations, not all applicants will be accepted for the Dismas House of KC Transformational Housing Program.  

For more information regarding openings for recovery housing, please call 816.542.0444.  

Pre-Screening Application
First Name and Last Name (Please enter the name provided on your legal identification.)
A contact number is required for a member of our staff to follow up with you on this application.
What is the applicant's date of birth?
Month
/
Day
/
Year
What is the applicant's gender?
When are you seeking recovery housing?
Choose the answer that is most applicable.
When was the last time that you abused a mind/mood altering substance?
Substance Use Disorder Treatment
Have you ever been enrolled in treatment for a substance use disorder?
Have you ever been diagnosed with a mental health disorder?
If you are not taking any prescribed medication, enter NONE.
Self-Harm History
Do you have a history of self-harm?
What is your current relationship status?
Children/Dependents
Do you currently have children in your care?
Pre-Trial, Charges and Sentencing
Are you currently awaiting charges, trial or sentencing for a crime?
Charges, Sentence, etc.
Who referred you to Dismas House of Kansas City for housing support?
Are you currently employed?
Do you currently receive disability or some other form of income monthly?
Do you presently have any physical, mental or behavioral challenges that would limit your participation in treatment and/or sustaining employment?
If you answered yes, please provide us with an explanation of your limitations:

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