Adastra Enterprises – Apply

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

First Name *

Last Name *

Current Contact Information (self or friend/family):

Address

Address 2

City

Zip / Post Code

Phone

Email *

Date Housing is needed

Employer’s contact information:

Employer

Address

Address 2

City

Zip / Post Code

Phone

Email

If not employed, what income stream will you use to pay monthly rent?

Are you currently on probation or parole?

Yes
No

If yes, please provide contact information for your supervision officer:

First Name

Last Name

Phone

Email

If yes, how long will you be on probation or parole and when is your next court date/hearing?

What is your last date of use of alcohol or other controlled substance?

Please write on your interest in the house, your recovery plan, your perceived strengths and areas for improvement, and a little more detail about yourself.