Important Notes:
In order to focus on healing, residents are not employed outside the home during their program stay at Legacy, nor will they have possession of personal mobile devices
The application fee will be applied to the entrance fee upon acceptance
The application fee will be refunded if the application is declined
Please answer thoughtfully and thoroughly.
Applications with incomplete answers will not be considered.
How did you hear about Legacy?*
Did you complete high school?*
Did you or do you attend college or trade school?*
II. MARRIAGE & RELATIONSHIPS
Complete this section if you have children and/or have ever been married. Otherwise, proceed to section III.
Do you have any previous marriages?
Do you have any medical conditions or health issues that require regular visits to your doctor?
Do you have a Naltrexone implant?
Are you currently using alcohol and/or drugs?
Are you currently taking any prescription medications?
Do you anticipate needing this medication while you are in the program?
Have you ever used prescription drugs for non-medical purposes?
**Legacy women must have a negative drug test prior to admission**
Have you ever been diagnosed by a mental health professional?
Have you ever been hospitalized for behavioral or emotional problems?
Have you ever attempted suicide?
Check all health issues you currently have or had in the past.
Do you have any allergies? (food, seasonal, animal, etc?)
Do you have any dietary restrictions?
Do you have any existing dental problems?
Are you aware that Legacy has a routine physical work component?
Do you have a physical limitation that would require accommodation for performing physical work? (Ex. bad back?)
Legacy is not a medical facility. If your health requires you to see a doctor on a regular basis this program may not be for you. We have no medical staff on site and are limited to basic first-aid. In case of an emergency we will take you to a local hospital. In the case of acute illness, we will take you to a local clinic to see a healthcare professional. If doctor appointments become required on a frequent basis, you may be subject to a medical discharge from the program.
Do you understand that Legacy is not a medical facility?
IV. LEGAL
We will perform a background check prior to admission. Criminal history does not necessarily disqualify you from the program.
Have you ever been arrested or in jail?
Are you on Supervision, Parole, or Probation?
Are you court-ordered to enter a recovery program?
Do you have a valid driver’s license?
If no, do you have a state ID?
Are you currently receiving any kind of government assistance?
If yes, check all that apply:
The above information is true to the best of my knowledge.
