Apply for Services | Rogue Retreat

Fill out the online application below (which may take between 30 minutes to an hour) or download and print the Rogue Retreat Application PDF.

Each adult in the household must fill out and attach a separate application.

Please read the description for each program and check the box for those you want to apply for.

APPLY FOR

The first is Restart Retreat. These properties are owned and managed by Rogue Retreat. It is an affordable housing second chance renters program for those who are homeless and need a fresh start. Participants are responsible for paying full rent and utilities.

The second is Housing Retreat, owned by the Housing Authority of Jackson County and co-managed with Rogue Retreat. It is a rent subsidized program for people who are currently and chronically homeless. Participants pay 30% of their adjusted gross income for rent and utilities.

The third is the Haven House’s, Women’s And Men’s recovery house’s operated by Rogue Retreat with preference given to people coming directly out of inpatient treatment, referred by one of our treatment partners. Program fee applies.

Haven

1 Bed Room

2 Bed Room

Haven

1 Bed Room

2 Bed Room

APPLY FOR Second

The fourth is Hope Village. These tiny houses are owned and operated by Rogue Retreat and will be a safe place for people experiencing homelessness to live while they address the situations that contributed to their homelessness. There is no running water and no electricity in the houses but all amenities are on site. Program fee applies.

To apply: Applications will be placed on our waiting list according to date and time received, program, and bedroom size. Please keep us updated if your contact information, family size, living situation, or income changes.

Online applications will be emailed to us. Printed applications may be dropped off at our office at 711 E Main St. #25, Medford, OR 97504 or faxed to 541-690-1670.

You need to call once a month to check in 541-499-0880.

Income eligibility for all programs must make less than 50% area median income below:

2020 Area Median Income - 50% AMI mo/yr (choose one)

Rogue Retreat Supportive Housing Program Requirements

All participants have the weekly support of a case manager who helps set goals and work towards a better life for themselves and their families.
All participants receive training on how to care for their apartments by having weekly housing inspections that can be adjusted to bi-weekly and then monthly.
All participants attend a weekly Life Skills class to connect with other agencies that provide resources and learn how to be successful in all areas of life. Childcare and transportation are provided for the class.
Rogue Retreat is a drug and alcohol free housing program including THC.
While program requirements are primarily the same for all programs, the income eligibility, homeless requirements and criminal history component varies by program.
Restart Retreat, Housing Retreat, Heather’s Haven and Harold’s Haven all require you to have at least 60 days clean and sober prior to being admitted.
Hope Village does not have any clean time requirements however all residents must demonstrate a willingness to want to be clean and sober and agree to work towards that goal.

Contact Information

Name

First Last

Email

Address

Street Address City State ZIP Code

Home Phone

Cell Phone

Msg. Phone

Information required for all household members who will live with you at Rogue Retreat (list yourself first)

1. Your Full Name

Date of Birth

Gender

Social Security #

Check all that apply

VET = Veteran

SA = Substance Abuse

DV = Domestic Violence

MH = Mental Health Diagnosis

OHP ID Number

Indicate Allcare or JCC

Allcare

JCC

Do you need to add another member?

Yes

No

Other Household Member(s)

2. Full Name of other household member

Date

Gender

Social Security #

Check all that apply

VET = Veteran

SA = Substance Abuse

DV = Domestic Violence

MH = Mental Health Diagnosis

OHP ID Number

Indicate Allcare or JCC

Allcare

JCC

Do you need to add another member?

Yes

No

Other Household Member(s)

3. Full Name of other household member

Date

Gender

Social Security #

Check all that apply

VET = Veteran

SA = Substance Abuse

DV = Domestic Violence

MH = Mental Health Diagnosis

OHP ID Number

Indicate Allcare or JCC

Allcare

JCC

Do you need to add another member?

Yes

No

Other Household Member(s)

4. Full name of other household member

Date

Gender

Social Security #

Check all that apply:

VET = Veteran

SA = Substance Abuse

DV = Domestic Violence

MH = Mental Health Diagnosis

OHP ID Number

Indicate Allcare or JCC

Allcare

JCC

Do you need to add another member?

Yes

No

Other Household Member(s)

5. Full name of other household member

Date

Gender

Social Security #

Check all that apply

VET = Veteran

SA = Substance Abuse

DV = Domestic Violence

MH = Mental Health Diagnosis

OHP ID Number

Indicate Allcare or JCC

Allcare

JCC

Do you need to add another member?

Yes

No

Other Household Member(s)

6. Full name of other household member

Date

Gender

Social Security #

Check all that apply

VET = Veteran

SA = Substance Abuse

DV = Domestic Violence

MH = Mental Health Diagnosis

OHP ID Number

Indicate Allcare or JCC

Allcare

JCC

Do you need to add another member?

Yes

No

Other Household Member(s)

7. Full name of other household member

Date

Gender

Social Security #

Check all that apply

VET = Veteran

SA = Substance Abuse

DV = Domestic Violence

MH = Mental Health Diagnosis

OHP ID Number

Indicate Allcare or JCC

Allcare

JCC

Do you need to add another member?

Yes

No

Other Household Member(s)

8. Full name of other household member

Date

Gender

Social Security #

Check all that apply

VET = Veteran

SA = Substance Abuse

DV = Domestic Violence

MH = Mental Health Diagnosis

OHP ID Number

Indicate Allcare or JCC

Allcare

JCC

Do you need to add another member?

Yes

No

Other Household Member(s)

9. Full name of other household member

Date

Gender

Social Security #

Check all that apply

VET = Veteran

SA = Substance Abuse

DV = Domestic Violence

MH = Mental Health

OHP ID Number

Indicate Allcare or JCC

Allcare

JCC

Do you need to add another member?

Yes

No

Other Household Member(s)

10. Full name of other household member

Date

Gender

Social Security #

Check all that apply

VET = Veteran

SA = Substance Abuse

DV = Domestic Violence

MH = Mental Health

OHP ID Number

Indicate Allcare or JCC

Allcare

JCC

Where do you sleep at night (be specific):

Have you been homeless for one year or more or four or more times in the past 3 years?

Yes

No

Do you have a therapy animal or pet?

Yes

No

If yes, describe:

How long have you lived in the Medford/Jackson County area?

If less than 2 years, why did you move to the Medford/Jackson County area?

Income and/or Benefit Information

Current Employer:

Supervisor:

Work Address:

Work Phone:

How long have you worked here?

How many hours per week do you work?

How much do you earn per month?

Do you receive SNAP (food stamps)?

Yes

No

Amount:

Do you receive income from any other source? (Where from and the amount)

Source:

Amount:

Source:

Amount:

Additional Contact Information

Person to be contacted:

Name

Full name

Relationship to you

Phone

Address

Home Address City State ZIP Code

Intake Information (questions 1-9)

PLEASE ANSWER THESE QUESTIONS FULLY AND TO THE BEST OF YOUR KNOWLEDGE SO WE KNOW HOW WE CAN HELP YOU BEST.

1. Tell us about yourself, for example: How did you become homeless? Who are you? What experiences have you had in life that have made you who you are as a person? How do you see yourself in the future, what do you want to be? What are your weaknesses and your strengths? Other than housing, what are your goals and dreams and how can Rogue Retreat help you accomplish them?

2. What are your housing barriers? What keeps you from finding stable housing?

Examples: Income, criminal history, no rental history, bad rental history, evictions, poor credit or lack of, etc.

3. Are you involved with any community agencies? Who is your Case Manager or Worker? Please include their phone number. If you are not currently involved with any agencies please list 4 non-related personal references.

CONTACT NAME

AGENCY/COMPANY

PHONE #

4. Do you have any current Physical Health Conditions that have been diagnosed? If yes: do you have a Primary Care Physician? Are you on any prescription medications? If so, what are they? You must provide a current prescription, in your own name, for any and all narcotic medications at the time of interview.

5. Do you have any current Mental Health Conditions that have been diagnosed? If yes: are you a current client at Jackson County Mental Health, Columbia Care or Options? Are you on any prescription medications? If so, what are they? You must provide a current prescription, in your own name, for any and all narcotic medications at the time of interview.

Rogue Retreat Application

Income eligibility for all programs must make less than 50% area median income below:

Rogue Retreat Supportive Housing Program Requirements

Contact Information

Information required for all household members who will live with you at Rogue Retreat (list yourself first)

Other Household Member(s)

Other Household Member(s)

Other Household Member(s)

Other Household Member(s)

Other Household Member(s)

Other Household Member(s)

Other Household Member(s)

Other Household Member(s)

Other Household Member(s)

Income and/or Benefit Information

Do you receive income from any other source? (Where from and the amount)

Health Insurance Information

Additional Contact Information

Person to be contacted:

Legal Information

Intake Information (questions 1-9)

Questions 1-9 continued

Important Information