A place to begin again

Recovery grows where hope feels at home.

Penelope’s House offers women a welcoming place to build stability, practice accountability, and move forward one day at a time.

Compassion. Structure. Community. A fresh start.

Application

Take the first step.

Welcome to our transition house for recovery from addiction for women. Our program provides a supportive, faith-centered environment to help women transition back into society with dignity and hope.

Program fees

$400 initial fee, paid after approval and before move-in. $200 per week starting after the first two weeks.

Private preview: This application is for layout testing only. Do not enter real personal or medical information. Nothing entered here is sent or stored.

Fields marked * are required. For a written question that does not apply, enter “Not applicable.”

Personal Information. (All fields are required to be completed.)

Full Name *Date of Birth *Phone Number *Email Address *Current Address *Social Security # *Do you have children? *If yes, names and ages? *Are any of your children in DSS custody? *If yes , where? *Name and phone number of case worker if applicable *Who is currently caring for your children? *

Emergency Contact Information

Emergency Contact Full Name *Relationship to Applicant *Emergency Contact Phone Number *Emergency Contact Email

Background Information

Criminal History

Have you ever been convicted of a crime? *If yes, please provide detailsAre you a registered sex offender? *Are you currently on probation or parole? if so name and phone number of officer? *If yes, name and phone number of the officer *

Substance Abuse History

Have you struggled with substance abuse? *If yes, please describe your substance abuse historyDate of last substance useHow long have you been sober? *Do you have a sponsor? *Name and phone number *

Previous Treatment Programs

Have you participated in treatment programs before? *If yes, please list previous treatment programs and dates

Medical/Mental Health History

Do you have any medical conditions we should be aware of? *If yes, please describeDo you have any mental health diagnoses? *If yes, please describeAre you currently taking any medications? *If yes, please list medications, dose and frequency of eachAre you currently working with a mental health practitioner, psychiatrist, or counselor? *Do you have any physical limitations or disabilities *If yes, please provide details *

Employment History

Are you currently employed? *If yes, employer name, address and phone numberPositionBrief Employment HistorySource of income if not employed *

Educational Background

What is the highest Level of Education Completed *

Referral Information

How did you hear about our program? *

Additional Information

Do you have a valid driver's license? *Driver's License NumberDriver's License State

Program Goals and Commitment

What are your goals for participating in this program? *Why do you believe this program is right for you? *

Acknowledgment and Agreement

I understand that acceptance into the program requires an initial fee of $400 (due after approval, before move-in) and $200 per week starting after the first two weeks *I certify that all information provided in this application is true and complete to the best of my knowledge and PHLBF LLC has permission to contact and verify all information contained in the application. *I understand that PHLBF LLC is limited to providing a transition house to assist in recovery from addiction, and is not nor claim to be a detoxification facility, a medical program. It does not pay for medications, and is not a licensed medical treatment center. *I waive my rights to legal action against PHLBF LLC its staff or volunteers based on any counseling i may receive. *Please print name *Date *Signature *Date *

Living together

House mandates & rules.

Please read these expectations before applying. They describe the responsibilities, routines, and standards for residents of Penelope’s House.

Curfew

Sunday–Thursday: 10 PM
Friday–Saturday: 11 PM

Quiet hours

10:30 PM–7 AM daily

Recovery commitment

Recovery meetings three times a week; church once a week; find a sponsor within 30 days.

Core mandates

Use of drugs or alcohol in any form on or off premises is prohibited.
Possession of any drugs, or drug paraphernalia, alcohol or weapons is prohibited.
No physical violence, or threat of physical violence, on or off premises.
Leaving overnight without permission.
Refusal to cooperate or being unwilling to calm down with a staff member.
Failure to submit to a drug test, a positive test, or a temperature strip showing too high or too low.
Leaving the property within a 14-day period without permission.
Refusal to take prescription medication as directed. Do not share with another resident.
Refusal to submit to medical treatment when necessary.
Refusal to follow Christian principles, i.e. excessive public displays of affection or not postponing sexual relationships
Unwilling to postpone any relationship with anyone in active addiction or use any mood-altering substances i.e. CDB, MAT, Kratom.
This can include the companion being subject to drug screening, for relationship to continue.
Theft of property of any, resident, staff member, or house.
Choosing to be in environments that impact your recovery. i.e. bars, lounges or questionable residences.

Violation of these above mandates will result in immediate dismissal.

House conduct and responsibilities

Disrespectful behavior towards anyone in the house.
Sharing outside information with ladies in treatment. Ie. All social media posts. Traumatic family information, good news or bad news. It is up to staff or family to deliver that information.
Failure to attend, tardiness, or leaving early for required activities.
Missing established curfew. Sunday- Thursday, 10PM, and Friday-Saturday, 11PM.
Smoking inside the house, including all areas designated nonsmoking. Vaping is acceptable.
Moving furniture in the house and/or putting things on the walls except for what is already there.
Using any area in the bedroom, closet, pantry, or refrigerator space that is not designated to you.
Leaving personal things in common areas.
Feeding or caring for animals inside or outside the property.
Excessive public displays of affection in public are prohibited.
Allowing a resident within the first 14-day period to use your electronic devices, without getting permission from a staff member.
Failure to keep room in proper order.
Failure to complete timely, assigned chores 3 times a week.

Violation of these above mandates will result in immediate formal notice. Receipt of (3) of these written notifications in a 90-day period will result in dismissal.

Daily living and recovery rules

Make my bed daily
Sleep in my bed at night
Wash my bed linens weekly
Label all food and laundry detergent
Keep my pantry and fridge space neat and organized
Keep all clothes, shoes and linens inside my closet, drawers and/or clothes hamper.
Store personal grooming items out of sight. Ie. Bathroom
Store weekly prescribed medications out of sight.
Find a sponsor within 30 days of move in date to assist with your recovery.
Attend church services once a week.
Attend recovery meetings 3 times a week.
Refrain from using profanity, slander, gossip, pornography, off color jokes and racial slurs or intolerance.
I will not resign from my source of income until I find another source.
I agree to pay established rent on a weekly or bi- weekly basis due on day of house meeting. (Monday)
I agree if receiving funds from SSI, to volunteer 10 hours a week of my time.
I will not borrow or lend money or personal belongings to any residents, staff members or volunteers.
I agree to observe quiet hours daily from 10:30 pm to 7 AM daily. This includes phone calls and conversations and preparation of food and washing dishes in the house, kept to an acceptable volume and or use of any electronics without ear buds or headphones. This includes hair dryers or any noise producing personal appliances and house washers and dryers.
I will follow the established dress code of dressing classy not trashy.
I will lock all exterior doors behind me whenever I enter, or leave Penelope’s house
I will not leave Penelope’s house walking afer dark.

Acknowledgment

I the undersigned hereby agree and acknowledge I have read and understand the mandates, rules, and violations and assume all risks applicable to my residence at Penelope’s house.

I also permit Penelope’s house to release information and records regarding me as required by law. I understand and agree with random drug screening.

The original document includes spaces for your printed name, signature, and dates.

Download the house rules

Recovery grows where hope feels at home.

A home centered on dignity and forward movement.

Our purpose

Dignity

Accountability

Belonging

A six-month commitment to building a stronger foundation.

Six-month program

$400 intake fee

Identification

A simple, respectful intake process.

Complete the application

Application review

Phone conversation

Admission decision