Recovery Residence Certification Application Application for CTARR Affiliation Load saved progress Checking for saved data... Fields marked with an * are required Section 1 - Organizational Information Section 1 - Organizational Information Initial Certification or Re-certification? * Initial Certification Re-certification HTML For re-certification, if no changes since your last submission, complete Section 1 then skip to and complete Sections 6, 7 and Payment Name of Organization * Organization Type * (corporation, partnership, LLC, nonprofit corp., sole proprietor) State of Origination or Incorporation * Year Founded HTML Copy Contact InformationPrincipal Business Address Address * Address 2 City * State * Zip * Mailing Address Mailing Address Same as Principal Address Address 2 City State Zip Principal Contact Person Principal Contact Person First Name * Last Name * Title/Position CEO, Owner, Executive Director, etc Contact Phone * Contact Email * Website Section 2 - Residences operated by this applicant Section 2 - Residences operated by this applicantPlease provide the following information for each recovery residence you operate. All recovery residences you operate must be included. Residence Name 1 * Address * Address 2 City * State * Zip Level of Support Level One Level Two Level Three Residence Capacity * Gender(s) Served * Men, women, co-ed, women with children, men with children or families with children Accepts Minors? Yes No Contact Person Monthly Fees Divider Additional House (2) Divider Copy Additional House (3) Divider Copy Copy Additional House (4) Divider Copy Copy Copy Additional House (5) Divider Copy Copy Copy Copy Space Copy Copy Copy Copy Section 3 - Standards, codes of ethics, dispute resolution Section 3 - Standards, codes of ethics, dispute resolution Do you maintain formal standards for the operation of your recovery residences? * Yes No Do you maintain a code of ethics to which all members subscribe, or do your standards contain provisions equivalent to a code of ethics? * Yes No Do you agree to adopt the CTARR Standard for Recovery Residences for all recovery residences operated by your organization? * Yes No Do you have a defined process for resolving complaints from residents and the public? * Yes No Do you maintain and follow procedures for logging and retaining records of complaints about your residences, and the manner in which they were resolved? * Yes No Section 4 - Support for CTARR activities and mission Section 4 - Support for CTARR activities and mission Are you willing to participate in CTARR activities and programs? * Yes No Are you willing and able to support CTARR-sponsored research initiatives? * Yes No Are you willing and able to contribute financially to the operation of CTARR by payment of applicable annual affiliate fees? * Yes No Do you intend to conform to affiliate requirements which are enacted by CTARR for adoption by its affiliates? * Yes No Do you intend to conform to affiliate requirements which are enacted by CTARR for adoption by its affiliates? Copy * Yes No Section 5 - Annual fees Section 5 - Annual feesAffiliate fees for recovery residence providers are based on residential capacity. This section will help you calculate the affiliate fee for your organization based on your capacity. Enter the total number of beds for each individual residence you are registering. The Total Amount Due (shown at the bottom of the page) is the sum of the $300 application fee, $100 for each additional recovery residence and the capacity-based charges based on your capacity. Comments or Questions Section 6 - Supporting documentation Section 6 - Supporting documentationPlease save all files as PDF's before attempting upload 1. House Rules* Select Files Cancel 2. Policies and Procedures, Standards of Operating or Equivalent* Select Files Cancel 3. Informational Material About Your Organization Select Files Cancel 4. Code of Ethics (if not included elsewhere) Select Files Cancel 5. Resident Agreement* Select Files Cancel 6. Documentation of legal business entity (e.g. incorporation, LLC documents or business license)* Select Files Cancel 7. Copy of current liability insurance of $500,000 or more and other insurance appropriate to the level of support* Select Files Cancel 8. Copy of lease agreement if you are not the owner of the property Select Files Cancel 9. A statement attesting to compliance with nondiscriminatory state and federal requirements* Select Files Cancel 10. Residence Photos* Select Files Cancel HTML One letter of recommendation, emailed by reference source directly to CTARR info@ctrecoveryresidences.org Section 7 - Certification Section 7 - CertificationCertification I certify that this application is supported by the applicant organization named above, and that I am authorized to submit this application on its behalf. First Name * Last Name * Title/Position * Signature * Typing your name here is agreeing that you are authorized to submit this application Payment PaymentPayment - your application will not be processed unless payment is received Annual Application Fee Annual Application Fee: $300* * Enter Number of Additional Houses Enter Number of Additional Houses @ $100 Bed Fee - enter total bed amount Bed Fee @ $1.00 - Enter total bed amount: Total Total: $300.00 HTML Please save your progress before submitting form. If you are a human seeing this field, please leave it empty.