Blessed Builders Sober Living Homes Residential Application Apply online below or print a PDF application Personal InformationFull Name(Required) First Middle Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Date of Birth MM slash DD slash YYYY Social Security Number Marital StatusSingleMarriedDivorcedSeparatedEngagedWidowedPhoneOther PhoneAre you a veteran? Yes No Email Enter Email Confirm Email Present Housing Situation Live with spouse Live with Parents Live with Relative Live with friends Incarcerated Treatment facility Homeless Live alone Other Emergency Contact Person (Friend or Family Member)Full Name(Required) First Middle Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Daytime Phone #Evening Phone #Cell #Relationship to you Email Address Spouse's InformationFull Name First Middle Last Address Street Address City State / Province / Region ZIP / Postal Code Daytime Phone #Evening Phone #Cell #Children's InformationName First Sex Male Female AgeDOB MM slash DD slash YYYY Name First Sex Male Female AgeDOB MM slash DD slash YYYY Name First Sex Male Female AgeDOB MM slash DD slash YYYY Name First Sex Male Female AgeDOB MM slash DD slash YYYY Name First Sex Male Female AgeDOB MM slash DD slash YYYY Name First Sex Male Female AgeDOB MM slash DD slash YYYY Educational BackgroundHighest level of school completed List of schools, certi cates and diplomasReligious AffiliationName of Church Address Street Address City State / Province / Region ZIP / Postal Code Name of Pastor Phone #Additional InformationWhat is your gender? Male Female Are you a sex offender? Yes No Any crimes/offenses? What is your drug of choice? How long have you been sober? What is your current residency? Are you on probation? Yes No Who is your Probation Office? MedicationAre you currently taking medications? Yes No Please list medicationsSignature Reset signature Signature locked. Reset to sign again Blessed Builders Sober Living Homes grew out of the need to help more people. These people needed to have a safe and supportive place to live while they work on sobriety and BUILDING a life free of drugs or alcohol. Looking for Sober Living? Begin your Journey Contact Us Today Donate PHONE: 701-751-0318TEXT LINE: 701-660-0767FAX: 701-751-2354 *protected email* Location: OFFICE: 701-751-0318 FAX: 701-751-2354 MON-THURS 10am - 5:30pm 2700 State St. Ste F-6 Bismarck ND 58503 (Gateway Mall)
