Forged by Christ Ministries, Inc
Men’s
Discipleship
Center
Application
1 Peter 5:10 (ESV)
And after you have suffered a little while, the God of
all grace, who has called you to his eternal glory in
Christ, will himself restore, confirm, strengthen, and
establish you.
Applicants Information
FOR QUESTIONS CALL 660-492-6736
(If any of the information you provide is found to be false your application will be
automatically denied, and you will not be reconsidered at any time.)
Print Full Name: Client first nameClient last name
Email Address: Text field
Address: Client Address
City: Client City State: Client State Zip Code: Client Zip
Phone: Client phone SSN: SSN
D.O.C #: Text field D.O.B Client birthdate
Are you a sexual offender? Radio buttons
(We do run criminal background checks!)
If yes, please explain:
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PLEASE READ BEFORE CONTINUING
This program is for professing Christians only. This is a Christian discipleship program, and we are designed to create Soldiers for God’s Army. Our recovery is Christ centered and based on Christian Theology. We focus on biblical principles and God’s healing Grace. We believe through the power of the blood of Jesus Christ and with the Holy Spirit working through you, you will be able to overcome all your life’s issues in accordance with God’s will. If you are a non-Christian, then it would not be fair for us to ask you to follow our structure. Let’s just be honest, if your way worked, then you would not need this program. You must be willing to submit to God’s plan for your life and the new way of living you will learn in our program. Holding onto anything from your past will only hinder your progress in life and your relationship with God. If you answer NO to any of the following questions, then THIS PRORGRAM IS NOT FOR YOU! Only willing participants need apply.
ARE YOU WILLING TO DO WHATEVER IT TAKES TO CHANGE YOUR LIFE?
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ARE YOU WILLING TO GIVE UP YOUR CRIMINAL MENTALITY?
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ARE YOU WILLING TO COMMIT ONE YEAR TO THE DISCIPLESHIP OF FORGED BY CHRIST MINISTRIES, INC?
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ARE YOU WILLING TO PUT OFF ANY TYPE OF ROMANTIC RELATIONSHIP AND FOCUS ON YOUR RELATIONSHIP WITH GOD?
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Congratulations if you answered yes to all the questions!
Now, if accepted, we can help!
Please, tell us all about yourself and why you want to change.
Give us a brief description on why you want to be a disciple of Christ and what exactly being a disciple means to you?
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Please share you Christian Testimony (The brief story of your life before Christ, how you came to know Christ, and your life since you became a Christian, an where you want to go with Christ.)
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List at least two references and their contact information, so we can confirm your information.
| Name: Text field |
Phone: Text field |
Relationship: Text field |
| Name: Text field |
Phone: Text field |
Relationship: Text field |
| Name: Text field |
Phone: Text field |
Relationship: Text field |
Do you have children? Radio buttons
If yes please list names, ages, do you have a relationship with them and their mother/mother’s.
Do you have a relationship with?
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Do you have a relationship with? |
| Name: Text field |
Age: Text field |
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| Name: Text field |
Age: Text field |
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| Name: Text field |
Age: Text field |
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| Name: Text field |
Age: Text field |
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| Name: Text field |
Age: Text field |
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| Name: Text field |
Age: Text field |
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Do you have any pending charges or court dates? Radio buttons
If yes, please list:
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Are you on probation or parole? Radio buttons
If yes:
For what and until when:
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Parole/Probation Officer Name: Text field
City: Text field Phone: Text field
Do you have any protection orders in effect against you? Radio buttons
If so, please explain:
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Are you currently prescribed any type of medication? Radio buttons
Note anyone who is medicated due to psychological issues need not apply. We are not a medical center and we do not staff med techs. So, we cannot accept this type of client.
What medication are you currently prescribed to take?
Medication
When was the last time you used drugs or alcohol and what?
| Drugs? |
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| Radio buttons |
What? Text field |
When? Text field |
| Alcohol? |
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| Radio buttons |
What? Text field |
When? Text field |
| Prescription drugs not your own? |
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| Radio buttons |
What? Text field |
When? Text field |
| Other mind-altering substances? |
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| Radio buttons |
What? Text field |
When? Text field |
PLEASE NOTE! You will be given a drug test upon arrival at the Men’s Center. If you test positive without previous notification, you will be automatically terminated from the program.
Are you in any type of a romantic relationship? Radio buttons
Are you Married? Radio buttons
If you answered yes to either or both please answer:
Name of person/wife: Text field
Currently together: Radio buttons If Yes, How long? Text field
Where do they live? City: Text field State: Text field
Are they actively addicted? Radio buttons
Have they ever been? Radio buttons
Is the relationship currently: Radio buttons
If married, is Christian Marriage counseling be something you would be willing to do? (If yes, we will be happy to refer you.)
Radio buttons
Are you currently in jail, rehab, or prison? Radio buttons
If yes what facility? Name: Text field
City: Text field State: Text field
Phone number: Text field Release Date: Date
APPLICANT’S SIGNATURE (Applicant's Full Name)
Signature
Printed Name: Text field Date: Date
Once we receive your application, we will review the information provided and confirm it. Then if you meet the criteria for the program, we will arrange either an in-person interview or a phone interview and talk about next steps. We look forward to talking to you soon.