top of page

Residency Application

Please complete the below residency application in its entirety. Contact Rick Newman if you have any questions regarding the status or questions within the below application by calling (260)665-7700.

If you prefer to print and complete a hard copy of the application, then please download the residency application (PDF) and email it to


Four County Transitional Living Inc.

Have you been clean & sober for at least 72 hours?
Do you have a valid driver's license?
Have you ever attended Alcoholics Anonymous or Narcotics Anonymous?
Are you willing to commit to a minimum of 7 meetings per week?
Are you willing to commit to stay at 4CTL for 270 days?
Are you involved in any legal action at this time?
Are you currently on probation or will you be?
Is your stay here, if approved, going to be court ordered?
If you answered no to the above question, it may be requested that your stay to completion of the program is written within your court order. Will that be a problem?


  1. Found to be using alcohol or drugs

  2. Is non-compliant with the house rules

I agree that all statements by me are true, I waive any resident rights while an occupant at Four County Transitional Living, Inc. I agree that 4CTL or its agent may use the above information for a background check.

Thanks for submitting!

bottom of page