Oxford House Indiana Re-Entry Intake

This form is for submitting completed Oxford House Indiana Re-Entry applications. Applications may be submitted by IDOC case managers, re-entry staff, referral partners, or other authorized support personnel.

Please download and print the paper application, have the applicant complete it, then upload the completed application as a PDF.

Download Paper Re-Entry Application

After submission, the system will generate a Case ID and route the application to Oxford Houses in the selected primary county.

Submitter Information

Submitted by role

Submitter Full Name

Submitter Email Address

Applicant Information

Applicant Full Legal Name

Applicant Gender

DOC Number/Case Number

Cause Number

Is the applicant currently incarcerated?

Facility name or "At Liberty"

Definite release date

Date of Release

Release Location / Routing

Primary County

Case Manager / Supervision

Case Manager Name

Case Manager Email

Supervision Status Upon Release

Documents

Upload Completed Re-Entry Application (PDF)

Upload additional supporting documents (optional)

Acknowledgment

Submission of an application does not guarantee acceptance by any Oxford House, reimbursement approval, funding availability, housing placement, or admission outcome.

Each Oxford House is autonomous except in matters affecting other houses, the state association, or Oxford House, Inc.

I understand and acknowledge the submission notice, privacy policy, terms of use, and disclaimer.