Application for Re-Accreditation Re-Accreditation Application Step 1 of 3 - Section I 33% Recovery Residence Operator New Accreditation applicant Re-Accreditation applicant HiddenMember New Member Existing Member Renewal Reinstate Membership Section I: Recovery Residence Information (please submit one application per residence)Residence name: Residence address: City: State: ZIP: Residence is owned by applicant leased from third party leased from person or entity related to applicant If applicable, do you have written permission from the owner of record to operate a Recovery Residence on their property? yes no Date residence established MM slash DD slash YYYY Type of structure: single family detached house apartment building One or more apartment units condominium unit(s) duplex or triplex other Serving: Men Women Women with Children Co-ed Men with Children Other population Resident capacity (Number of Beds):Number of bedrooms:Number of bathrooms:Other available space:HiddenLevel of recovery support (1-4, as listed above):NARR Type of Recovery Residence Support Type P / Level 1 Type M / Level 2 Type S / Level 3 Type C / Level 4 Resident fees: Monthly $Resident fees: Weekly $More than one fee for accommodations in this residence? yes no Is food included as part of resident fees? yes no Section II: Applicant Information (information on the organization or individual operating this residence)Applicant name: Applicant business address: City: State: ZIP: Type of business: corporation partnership limited liability company (LLC) sole proprietorship nonprofit corporation non profit-other unincorporated entity other Website Does applicant own and/or partner with a licensed alcohol & drug or mental health program or facility? yes no If yes, name of licensed program(s) or facility(ies): Number of recovery residences operated by this organization:Are you willing to participate in VARR activities and community social events? yes no Have you read and agree to fully comply with NARR 3.0 Standards as set by the National Alliance for Recovery Residences? yes no Mission:Please provide your mission statement:Vision:Please provide your vision statement:Do you have a written code of ethics? yes no Do you have general liability insurance? yes no Do you comply with all State and Federal requirements? yes no Do you maintain an accounting system that fully documents all resident financial transactions such as fees and payments? yes no Do you collect and report accurate process and outcome data for continuous quality improvement? yes no Do you adhere to applicable confidentiality laws? yes no Do you keep resident records secure with access limited to authorized staff only? yes no Do you have a grievance policy and procedure for residents? yes no Do you abide by all local building and fire safety codes? yes no Section III: Contact InformationPrincipal business contact for this member organization:Name: Position title or duties: Principal contact phone:Principal contact email: Responsible person for this residence (Manager, senior resident, peer leader, house captain or equivalent):Name: Position title or duties: Responsible contact phone:Responsible contact email: Section IV: Applicant affidavit and signatureI hereby attest that the above information is true and complete, and that I am authorized toexecute this application on behalf of the applicant. Applicant hereby requests accreditation by VARRLegal representative of applicant Date MM slash DD slash YYYY Name I have fully read* Further, I have fully read, understand, and agree to abide by the VARR Code of Ethics (document included in this application packet). EmailThis field is for validation purposes and should be left unchanged. Δ
