Your Anniversary is a Big Deal! We want to share in your special day – the anniversary of your sobriety. We honor grads on their anniversary date each month and want to include every single one of you. Please fill out the form below or download it and mail it to Wayside House so we can celebrate your sobriety date with you! Name Full name * Address Street City State AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming Zip Code Cell Phone * Home Phone Email Address * Sobriety Date * Continuing Care Did you follow the recommendations made when you were discharged from Wayside House? (optional) YesNoSomeNot Applicable What were those recommendations? (optional) (Check all that apply) AftercareIOPOPParentingMother's IssuesPsychiatric Follow UpSober HomeAdditional ResidentialAA/NA MeetingsOther Home & Family Do you live in Palm Beach County? (optional) YesNo If NO, what county and state? Do you currently RentOwn Significant events in sobriety (ex: marriage, divorce, births, deaths, home purchase, etc.) (optional) How satisfied are you in this area of your life? VerySomewhatNot Education Have you returned to school or received any specialized training since you left Wayside House? (optional) YesNo If YES, please explain: Employment Do you work? (optional) Full-TimePart-TimeStay-at-Home-Mom Please list your current occupation: (optional) How much has your income increased as a direct result of sobriety>(optional) 0-4%5-15%16-29%30-40%41-50%51-60%61-70%71-80%81-90%91-100% How satisfied are you in this area of your life? (optional) VerySomewhatNot Sobriety Maintenance Do you attend AA/NA and/or other self-help programs? (optional) OftenSometimesRarelyNever If so, please describe: Do you have a sponsor? (optional) YesNot at this time Do you sponsor others? (optional) YesNot at this time Spiritual In general, how spiritually "connected" would you say you are? (optional) VerySomewhatNot at all Has this area of your life changed as a result of recovery? Please explain: (optional) What is 3 + 2