top of page

"WIT-ness the Miracle of Recovery!"

Call: (260) 624-3178

Women In Transition – Resident Application

The mission of Women in Transitions is to provide a drug and alcohol-free community that allows women to establish a 12-step foundation to ensure continuing recovery. Thank you for your interest of services offered by Women in Transition. We believe that if you truly want to change a 12 Step Program is the answer. You must complete the entire application to be considered for residency. Do NOT leave any spaces blank. You may return this application by mail: 412 S. John St. / Angola, IN/46703 or by email: executivedirector@witangola.org. Upon receipt of your properly completed application, we will contact you by mail or you may complete the below online application form.

​

​

​​

**All Questions must be answered including the last page; N/A is not an answer.**

**If a question in not answered the application will be disposed**

Home Record Information: 

Education Level: Required
Form Of Identification Required
Valid ID? Required
Expired ID? Required
Birth Certificate? Required
Social Security Card? Required
Marital Status Required
Who Referred You to WIT? Required

Work History:

Use History:

Do you think your history of drug and/or alcohol use is a problem?

At what age did you first use? What situations cause you to use?

Have you ever been in a treatment setting for drug and/or alcohol abuse?

Is treatment mandated by the legal system?

Are you part of a drug court program; where:

If in recovery, what would help prevent relapse?

Family History

Has anyone else in your immediate family ever had problems caused by alcohol/drug abuse?

Have you ever overdosed?

Current Presenting Problem(s) Required

If any choices are marked, please explain when and where Diagnosed: *Must Answer*

List all Current Medications or Medications needed & currently taking:
*Must Answer*

**All questions must be answered**
*If any information is not disclosed truthfully or left out during application and later discovered it could lead to immediate dismissal from program

List pending case(s) & County of charge:

List past charges:

Reason Currently incarcerated:

What is your possible release date:

List all Battery Charges:

Why you would like to be a part of our program:

Any other information that we may need to know:

I certify that all the information that I have given is accurate to the best of my knowledge. I understand falsifying any information on this form is grounds for refusal of admittance or termination of residency. I authorize WIT to verify any or all of the information. I also understand that if accepted that rent is due in advance and is nonrefundable. I understand that my rent is a legal debt and if I fail to pay, WIT will use legal means available to collect and in such case, I will be liable for all collection costs.

Thank you for your submission!

bottom of page