Resident Application

By submitting this application, GLSL staff will be notified of your interest in our program and a member of our staff will be in contact with you shortly. Please note, applications are accepted on a first come, first serve basis.
Name*
First Last
Your Gender*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY
Current Phone*
Email*
Referred to GLSL By
Desired Sober House Location*
- 3rd Street House (Duluth - Men's House)
- The Log Cabin (Duluth - Women's House)
Requested Move-In Date*
MM slash DD slash YYYY
Sobriety Date*
MM slash DD slash YYYY
Current or Most Recent Treatment Facility
Other Current or Most Recent Treatment Facility
Counselor's Name
First Last
Counselor's Phone
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