Get Started | Unexpected Journey I

Get started with

Unexpected Journey

Complete this confidential form to help us determine eligibility and the next steps for support.

First name

Last name

Email address

Phone number

Who are you completeing this form for?

Myself

My child or family member

A client or someone I'm referring

Are you currently pregnant or the mother of at least one child?

Yes

No

Are you currently in recovery from a substance use disorder?

Yes

No

Are you willing to maintain sobriety and follow Unexpected Journey's recovery program and house expectations?

Yes

No

Are you currently participating in, or willing to participate in, recommended treatment and recovery support services?

Yes

No

Do you currently have custody of, or expect to have your child(ren) living with you during the program?

Yes

No

Not currently, but I am working toward reunification.

How many children will be living with you in the program

1

2

What's are the ages of the children who will be living with you?

Do you currently have a safe, stable place to live?

Yes

No

Temporary or unstable housing

Are you willing to participate in the program for up to 12 months while working toward independent housing?

Yes

No

I would like more information

Are you currently connected to a treatment or recovery support provider?

Yes

No

I need help connecting to services

Are you willing to participate in an intake and eligibility screening before admission?

Yes

No

Please tell us briefly about your current situation and what support you are seeking from Unexpected Journey.

If you are referring someone else, what is your name and organization?

If you are referring someone else, what is your phone number or email address?

Acknowledgement

I understand that submitting this form does not guarantee admission to Unexpected Journey. The information provided will be reviewed to determine eligibility and appropriate next steps.