Use This Form to Refer yourself, a friend, or a loved one to Emmaus House.

IMPORTANT: Filling out this form is the required FIRST STEP in the Admissions Process. It does NOT guarantee admission to Emmaus House. Only during an interview with the staff of Emmaus House can admission for anyone be secured.

If "Other", is selected, you will have to submit to a drug screen immediately, and it will have to come back clean. You need at least 30 days of sobriety to enter Emmaus House.