Resident application

Let’s start with your story.

A quiet, structured house in New Jersey. Take your time — there are no right answers here, and honest answers help us place you well.

About you

The basics, so we can reach you and plan your move-in.

Profile picture

A recent photo of your face. Staff use it to know who is moving in.

First name

Last name

Phone

Date of birth

Requested move-in date

This helps us understand your history and prepare the right support.

Home address before move-in

Current treatment center

The facility or program you are coming from. Write “None” if you are not in treatment.

Drug(s) of choice

Clean date

Best estimate is fine. Staff confirm this with you.

There are no right answers here. Your own words matter most.

Why do you want to get sober?

Besides sobriety, one tangible goal for your first 180 days

A job, a GED, a driver's licence, a rebuilt relationship — something you can point to.

Have you ever lived in a sober living or Oxford house before?

Answered honestly, these questions help us keep the house safe and support you properly. They do not automatically rule anyone out.

Do you have a criminal background?

Are you currently taking any medications?

Are you registered on Megan's Law?

We ask every applicant. A house manager will discuss any placement limits with you privately.

Someone we can call if there is ever a concern about your safety.

Contact name

Relationship

Contact phone

Your answers go only to Lux Residence staff.