THE BEACON APPLICATION (Sherman Hill Program & Village Apartments)

The Beacon (Beacon of Life) Program Application: One application. All of our programs.

This is one application for everything The Beacon offers. You do not need to know which program you want, and you do not need to choose one here. Fill this out once. After we review it, we will set up an interview with you, and together we will figure out which of our programs is the best fit for you and where you are right now.

Take your time. Answer honestly. There are no wrong answers on this form.

The two places you could live

Sherman Hill is a recovery program you live in. It runs six months to two years and moves through six phases. Your first five weeks are just about getting steady and safe. You share a room with three other women. You get a case manager, peer support, a food pantry, a clothing closet, and hygiene items. You need 30 days sober to come in, or 28 days if you are coming straight from a Medicaid funded treatment program. You do not need income to start. Program fees are $105 a week. Pregnant women are welcome.

The Village is your own apartment with a lease and a recovery program on site. It is a one person efficiency and you can stay as long as you like. You get a case manager and peer support. You need six months sober and legal income to sign the lease. Rent is $680 to $900 a month depending on the size, and that includes utilities, wifi, and laundry.

Both places are for women and for people who identify as or were socialized as female. Both are by appointment only. Neither one takes walk ups, which is how we keep everyone inside safe.

Why we ask so much

Some of these questions are not about whether you get in. We ask them because our funders require the numbers, and because knowing your situation is the only way we can tell whether you qualify for money or programs that might help you, here or somewhere else. If we find something you qualify for, we will tell you. We are not able to promise anything.

Where your answers go

Your answers go into our system, called OneStep, and nowhere else. We do not share them with other agencies. If you are admitted to The Beacon, we will enter you into the county homeless data system at that point, and we will explain it and ask you to sign for it then. Nothing goes there from this application.

If you need something changed to be able to participate

If you have a disability or a health condition and there is something we could change about how our program works so you can take part, you can ask us. It is called a reasonable accommodation. Asking does not count against you and it does not affect whether we admit you. You can ask now or any time later.

Welcome to The Beacon intake wizard
Click next to begin!

General Information

Where You Are Coming From

1. What is the zip code of the last place you lived? If you are not sure, give the city or the nearest cross streets.

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2. Who is filling out this application right now?

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For Referral Sources Only

If you are the applicant filling this out for yourself, skip this whole section. Type N/A in each box and keep going.

If you are filling this out for someone else, answer these five questions about yourself. This is the only place we ask about you. Everything after this section is about the applicant.

3. Your full name. Type N/A if you are the applicant.

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4. Your organization or agency, if you have one. Type N/A if you are the applicant or if you do not have one.

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5. Your relationship to the applicant. Type N/A if you are the applicant.

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6. Your phone number and email. Type N/A if you are the applicant.

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7. If you are filling this out for someone else: does the applicant know you are submitting this, and are they with you right now?

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Everything from this point forward is about the applicant.

If you are filling this out for someone else, answer every remaining question as the applicant. When a question says "you," it means the applicant. Use their situation, their history, and their words wherever you can. If you do not know an answer, write "unknown" instead of guessing. Do not answer with your own information.

8. Please confirm before you continue.

CheckboxesI understand. Everything after this is about the applicant.

How We Reach You/The Applicant

We do the interview by phone, so we need a number or an email address that gets checked every day. This is the part people most often get stuck on. If we cannot reach them, we cannot move their application forward, and we do not want to lose them over a phone number.

9. Applicant's phone number

Client Number

10. Is this phone checked every day?

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11. Applicant's email address. Type none if they do not have one.

Client email

12. Is this email checked every day?

 

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13. What is the best way to reach them to schedule their interview?

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14. What is the best time of day to reach them? Note that we cannot guarantee accomdation for this answer. 

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15. Is it okay for us to leave a voicemail or send a text about their application?

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16. If the applicant does not have a phone or email they check every day, who else can we call to get a message to them? Give a name, how they know the applicant, and a phone number. Type N/A if this does not apply.

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Applicant Information

What is your first name?
Client first name
What is your middle name? No middle name? Move on to the next question.
Client middle name
What is your last name?
Client last name
When is your birthdate?
Client birthdate
What is your race/ethnicity?
Client race
What is your gender?
Client gender
Do you socialize and identify as female?
Checkboxes
What is your marital status?
Client marital status
Are you a veteran?
Client veteran
 
Which of the following describes what you are recovering from? Choose all that apply.
CheckboxesIncarceration or justice involvement
Checkboxes Homelessness
CheckboxesDomestic violence
CheckboxesHuman trafficking
CheckboxesSubstance use/Addiction
 
Explain here:
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Substance Use History

Have you used alcohol illicit substances or non prescribed medications in the last 30 days
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Please provide details Enter NA if not applicable
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Have you used substances in the last 30 days
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Please provide details Enter NA if not applicable
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Have you used substances in the last 6 months
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Please provide details Enter NA if not applicable
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Both Beacon programs are sober living recovery residences Substances are not permitted on site and relapse is addressed with support safety planning and accountability Are you willing to live in a sober living environment
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Please share anything that would help us support you Enter NA if not applicable
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Have you ever been diagnosed with, treated for, or experienced challenges related to opioid or stimulant use (including methamphetamine, cocaine, heroin, or prescription pain medications)?

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If yes, please indicate if any apply:
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Please explain as much as you are comfortable:

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Housing Stability Screening (HUD-Aligned)

Are you experiencing homelessness housing instability or fleeing domestic violence

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Please describe your current living situation Enter NA if not applicable
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Which homelessness category or categories do they fall under? This is the definition our funders use, and it is separate from the question above.

Checkboxes Literally homeless: staying outside, in a car, or anywhere not meant for sleeping, or in an emergency shelter or transitional housing, or leaving an institution after 90 days or less when they were homeless before they went in
Checkboxes At imminent risk: they will lose their housing within 14 days, have nowhere else to go, and have no resources or support to get housing
Checkboxes Homeless under another federal law: unaccompanied youth under 25, or a family with children, who has gone a long stretch with no lease or steady housing and has moved repeatedly
Checkboxes Fleeing: fleeing domestic violence, dating violence, sexual assault, stalking, or human trafficking, with nowhere else to go and no resources to get housing
Checkboxes Exiting incarceration or jail
Checkboxes None of these fit. Not currently without housing and are not eligible

The Beacon is a long term 6 to 24 month recovery supportive program Are you looking for long term housing and structured support
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Please explain your goals Enter NA if not applicable

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Are you seeking long term stable housing, like The Beacon Village, where you can remain as long as you meet rent or program expectations?
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What does long term stability mean to you Enter NA if not applicable
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Do you currently have legal income?

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Please explain:

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Income Eligibility Screening 


The Beacon serves women whose income is at or below 30% of Area Median Income (AMI) at the time of admission. This helps make sure our housing and services are available to those with the greatest need. Income will be verified during the intake process.

What does 30% AMI mean?
It means your income is at or below the amounts listed below for Polk County, Iowa.

Yearly income limits (before taxes):

1 person household: $24,060 or less per year
2 person household: $27,480 or less per year
3 person household: $30,930 or less per year
4 person household: $34,350 or less per year
If you are not sure, that is okay. Our team can help you figure this out.

 

What is your current gross monthly income (before taxes)?
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What is your current gross yearly income (before taxes)?
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Do you currently own any property?

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Based on the information above, do you believe your income is at or below 30% AMI for your household size?
Dropdown:

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If you selected “Unsure,” please share anything you would like us to consider:
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Acknowledgment
Checkboxes

Recovery Expectations


Are you actively seeking support to build stability after experiencing addiction trauma mental health challenges or major life disruption
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Are you open to participate in weekly case management meetings
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At The Beacon Sherman Hill, residents participate in recovery wellness or mental health based meetings three per week at Sherman Hill and at least one per week at The Village Are you willing to meet this?
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Do you feel ready to begin a structured healing and recovery journey with accountability and community
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Contacts

Give us a few people that we can reach out to in case of an emergency.
Contact
Anything we need to know? Text field
 
If you have a parole or probation officer, please list their information below:
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RENT & FEE QUESTIONS

The Beacon at Sherman Hill requires a weekly program fee of 105 dollars that must be paid on time. Are you willing and able to pay the weekly program fee
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The Beacon Village requires signing a lease and paying monthly rent. Are you willing and able to sign a lease and pay monthly rent on time

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Do you currently have income that can reliably cover either the weekly program fee or monthly rent depending on placement

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Please describe your income source Enter NA if not applicable

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READINESS & GOALS

Sherman Hill requires participation in structured community living with weekly program fees. The Beacon Village requires independent apartment living with a lease and monthly rent responsibilities. Which environment do you feel prepared for today

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Are you looking for short term structured housing or long term independent housing where you can remain as long as you follow lease and program expectations

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Insurance

Enter your insurance provider(s).
Insurance
Checkboxes

Medical History

Tell us about your medical history.
When is your last day of use (substance/opiod/alcohol/unsafe behavior)
Date
When was your last relapse date?
Recovery history 1 relapse date
What is your substance(s) of choice? Add multiple by clicking in the box and selecting different options
Client substances of choice
Have you been clinically diagnosed with anything? Add multiple by clicking in the box and selecting different options
Client diagnosis
Do you have any health problems? Add multiple by clicking in the box and selecting different options
Client health problems
What kind of meetings do you attend? Add multiple by clicking in the box and selecting different options
Client kinds of meetings attended
What allergies do you have? No allergies? Move on to the next question.
Client allergies
 
 

Medication Stability Question

 Are you currently prescribed Medication Assisted Treatment (MAT) such as Suboxone, buprenorphine, methadone, or naltrexone?
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If yes:

Do you currently have active access to your medication and a prescribing provider?
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Required Acknowledgment
Initials Text field I understand that The Beacon (Sherman Hill and The Beacon Village) is not a detox or medical facility. If I am prescribed MAT, I must have a medical plan and stable access to my medication prior to admission.

 

Treatment Centers

Tell us about any treatment centers you've previously been admitted into.
TreatmentCenterHistory

Client Referral Source

Who referred you to us?
Client Referred By

Occupancy

 This part of the application for ONLY for an application is moving into a treatment center, inpatient center, etc. prior to their stay at one of our campuses
What facility will you applying to stay at?
Client facility

Sober Living History

Tell us about any sober livings you've previously been admitted into.
SoberLivingHistory

Employment

Tell us about your employment status.
If you're currently unemployed select "unemployed" under "type"
EmploymentHistory
 

Thank you for applying with The Beacon

Pressing submit means it reached us. You do not need to send it again.

We want to be honest with you about what happens next. We average around 200 people on our waitlist at any given time. Every application is read individually by a real person, not sorted by a computer, and we work through them as quickly as we can.

If you have not heard from us within three days, please call us at (515) 244-4713 ext. 1 and ask for an update. We are glad to tell you where things stand. What we cannot do is give you a specific date or time, because that depends on when a bed opens and who is ahead of you on the list.

Please do not come to our properties in person. We are appointment only and are not able to meet with anyone who arrives without a scheduled time. Calling is the fastest way to reach us.

If you need somewhere to go before we can reach you

Waiting is hard, and we do not want you without options in the meantime. These are free and available to you right now:

  • 211 Iowa — Dial 211, or text your ZIP code to 898211. Available 24 hours for food, shelter, utilities, and other immediate needs.
  • Primary Health Care Centralized Intake — 1200 University Ave., Suite 110A, west entrance. Walk-ins Monday through Friday, 8:00 AM to 3:30 PM. Arrive before 1:00 PM to be seen that day. (515) 248-1850. This is the front door for all homeless services in Polk County. 
  • Central Iowa Shelter & Services — 1420 Mulberry St. (515) 284-5719. Open 24 hours, low barrier, no cost. 
  • Children & Families of Iowa Domestic Violence Services — (515) 243-6147, answered 24 hours. Statewide line: 1-800-770-1650, or text IOWAHELP to 20121. 
  • Applying here does not affect your eligibility for any of these, and using them does not affect your place with us.

Thank you for trusting us with your application.