Main Office: 707.578.1830

Food Donations: 707.542.4817

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New Life Recovery Program

A ministry of the Redwood Gospel Mission

101 6th Street, Santa Rosa, CA. 95401 
Phone: 707-542-4817 Fax: 707-544-6185

NEW LIFE RECOVERY PROGRAM APPLICATION FOR ADMISSION

This is a huge step forward in your recovery. It takes a tremendous amount of courage to even apply to a program. We hope to be an encouragement to you as you move forward. We are not here to judge you; we are here to help. Please know that your information will be treated with the utmost respect for privacy. Any information obtained is for the sole purpose of determining if this program is a good fit for your needs and will not be released to any outside agency for any reason without your specific written consent to such a disclosure.

There are a few things we would like to tell you about our program up front:

  1. We are faith-based. You do not need to be a Christian to enter and we do not require that you become a Christian at any point in the program. However, our program is Bible-based and we do lead our classes from a Christian perspective. All we ask of you is for an open-minded and willing attitude towards Christian teachings.

  2. Unfortunately, our program is not able to accommodate those individuals who require psychiatric medications such as antidepressants, anti-anxiety, mood stabilizers, etc.

  3. We are a non-smoking program. Nicotine is a highly addictive drug and we recognize its negative impact on your overall health and well-being. You may use nicotine replacement therapies during the first 30 days of the program, but must be nicotine-free before phasing into the program.

  4. We are a time-out from romantic relationships (with the exception of a legal marriage, which is a separate issue).

  5. Because our program is designed for those who have no other resources, those accepted into the program are not allowed to accept any outside income (such as SSI, SSDI, Unemployment, GA, etc.) while in the program.

  6. The program can accommodate up to 40 men. Space is limited and so we do have guidelines on the number of items you can bring into the program. More information on this will be provided upon your acceptance.

 

More than anything- we want you to succeed in your recovery! If you have questions about any of the above, we encourage you to call Jim Lane at 707-542-4817 or by email at jlane@srmission.org.

 

Please fill out the following application honestly and thoroughly. Also, include a cover letter telling us about yourself and how your drinking/using has affected your life. Most importantly- please include a contact phone number and a contact address so that we may follow-up with you in a timely manner.

Marital Status:
High School Diploma/GED equivalent?
Are you a Veteran?

Family Matters

Do you have a drug or alcohol problem?
Any family history of drug/alcohol addiction?
Any family history of physical, emotional or sexual abuse in the family?
Do you have friends/ relatives who work at RGM?
Are you currently a staying as a guest at RGM?

Personal History and Status

Are you currently encarcerated?
Are you waiting to get into a program in order to be released?
Any problems with anger management?
Have you been tested for HIV?
Have you been tested for Hepatitis?
Have you been tested for TB?
Have you been tested for Sexually Transmitted Infections?
Are you currently taking any medications (including over-the-counter)?
Have you ever been in the military?
Discharge:
Do you have a drinking problem?
Are you an alcoholic?
Do you have a drug problem?
Are you addicted?
Have you ever been in a drug or alcohol treatment facility before?
Have you ever been arrested?
Any cases pending?
Are you on probation or parole?
Any other legal issues we should be aware of?

We believe in the Bible and in Jesus Christ. Our policies are designed around these beliefs. While you do not have to be a Christian to enter our program, we do ask that you are open to Christian teachings.

Do you believe in God?
Do you believe in Jesus?
Are you open to Christian teachings?

I hereby release the New Life Program from any and all claims which might arise from any harm or damage that may be suffered by me while in this program. I understand that I will be asked to give urine samples periodically for drug/alcohol/nicotine testing and agree to that testing. I understand that refusal to test, or a positive test result will result in my immediate dismissal from the program and the notification of probation/parole departments. I also understand that this is a non-smoking program and agree to become nicotine free while in the program. I understand that I may not receive any outside sources of income while in the program.

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