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Applicant Ranking
Select Your Market
(Required)
OKC Men
OKC Women
Tulsa Men
Tulsa Women
Wichita Men
Wichita Women
Kansas City Men
Kansas City Women
Crystal Coast, NC Women
Crystal Coast, NC Men
Greenville, NC Men
Claremore Men
Weatherford Men
DFW Men
Colorado Springs Men
Applicant Name
(Required)
Full name
Applicant Bio
(Required)
Are you a Veteran?
(Required)
Yes
No
1. Mental Health. A.Have you ever had a mental health diagnosis?
(Required)
0(Severe mental illness)
1
2
3(Depression/anxiety)
4
5(No)
i. If so, when?
(Required)
B. Have you ever attempted suicide?
(Required)
0(Tried)
1
2
3(Thought about it)
4
5(No)
C. What medications are you currently on?
(Required)
0(Banned meds)
1
2
3(All meds are allowed)
4
5(None)
Is it possible to wean off of? (If yes, give them a 2)
(Required)
D. Does mental health run in your family?
(Required)
0(Yes, on both sides)
1
2
3(Anybody with non-severe)
4
5(No)
2. Relationship Status A. Are you married or in a current relationship?
(Required)
0(In a relationship)
1
2
3(Married)
4
5(No)
B. Unless married, are you willing to not date for a year?
(Required)
0(No, wants to stay in a relationship)
1
2
3(Willing to break up/hesitated yes)
4
5
C. How is your relationship with your parents?
(Required)
0(No relationship at all)
1
2
3(Needs work)
4
5(Good/supportive/dead)
3. Financial Ability. A. Can you pay the $750 upon check-in?
(Required)
0(No)
1
2
3(Pay deposit, will struggle to get rest)
4
5(Yes)
B. Will you be able to obtain the $650 a month?
(Required)
0(No)
1
2
3(Yes once they get a job)
4
5(Yes)
C. Where are your finances coming from?
(Required)
0(No funds)
1
2
3(Anybody else paying)
4
5(Paying themselves)
4. Willingness. A. Are you willing to follow the HIA Rules and Regulations?
(Required)
0(No)
1
2(They have questions)
3(Hesitation)
4
5(Yes)
B. If you don't get to accepted to HIA, what is your back up plan?
(Required)
0(Going to another sober living)
1
2
3(I'll figure it out)
4
5(Only have eyes for HIA)
5. Treatment Center. A. How many treatment center have you been to?
(Required)
0(More than 8, or no treatment)
1
2(7)
3(5 centers, or detox only)
4(3)
5(1)
B. When did you last go to treatment?
(Required)
0(No treatment)
1
2
3(Last 90 days)
4
5(Currently in treatment)
i.Did you complete your last treatment center?
(Required)
Yes
No
Score
(Required)
