Application To The Draper House

  • Please fill out this application by providing the requested information as accurately as possible. This is important for us to decide to accept your application or not. Your information are confidential and will not be shared with any third party. Thank you.
  • I Hereby apply for membership in Draper House and I provide the following information for use by the Draper House staff in determining my eligibility and appropriateness
  • Basic information

  • Additional Information

  • Anyone taking Suboxone must submit an approval from MD or clinic
  • List names and phone numbers of two individuals to be contacted in the event of an emergency:
  • Draper House is a sober living environment and will not tolerate members using alcohol or drugs. If a member is found to be using either substance he will be immediately discharged.