Made For More Ministries, Inc

Residential Application

Personal Information

Date:

1. Full Name:

2. Date of Birth:

3. Gender:

4. Address:

5. City/State/Zip Code:

6. Phone Number:

7. Email Address:

8. Social Security number:

9. Driver’s License or ID number: State:

Emergency Contact Information

1. Full Name:

2. Relationship to Applicant:

3. Phone Number:

4. Email Address:

Background Information

1. Current Occupation:

2. Highest Level of Education Completed:

3. Are you currently employed?  _

If yes, please provide details:

4. Have you ever been convicted of a sex crime?

5. Do you have any felony convictions in the past 7 years? 

   If yes, please provide details:

6. Are you willing to submit to a background check?

7. Are you currently on parole or probation?

  If yes, please provide your officers contact information:

  State and county:

  Officers Name:

  Officers phone number:

  Officers email:

8. Are you mandated to this program?

  If yes, by what county?

9. Are you currently under the care of a physician or mental health professional? 

   If yes, please provide details:

10. Are you taking any medications?

  If yes, please provide details:

Substance Use and Recovery History

1. What substances have you used in the past?

2. When was the last time that you used and what substance?

3. How long have you been struggling with substance use?

4. Have you previously participated in any recovery programs?

   If yes, please provide details:

5. What steps have you already taken towards recovery?

6. What are your primary reasons for seeking recovery at this time?

1. Are you currently affiliated with a faith community or church?

   If yes, please provide details:

2. How important is your faith or spirituality in your recovery process?

3. Have you participated in any faith-based recovery programs before? 

   If yes, please provide details:

Program Commitment

1. Why are you interested in this particular faith-based recovery program?

2. What are your personal goals for participating in this program?

3. Are you willing to commit to attending all scheduled meetings and participating actively in program activities?

4. Do you have any concerns or questions about the program that you would like to discuss before joining?

Additional Information

1. Is there any additional information you would like to share that may help us better understand your needs and support you during your recovery journey?

Agreement and Signature

I understand that providing false or misleading information on this application may disqualify me from participating in the program. I agree to be honest and forthcoming about my background and current situation. I also agree to adhere to the guidelines and expectations of the faith-based recovery program.

Signature:

Date:

I desire to participate in a sober living community with Made For Ministries, Inc. Should I be accepted into the program, I release and forever discharge Made For Ministries, Inc. and any other ministry/organization involved and each of their respective members, employees, officers, directors, representatives and volunteers from any and all claims for any and all injuries, illnesses, losses or damages I might have in any way relating to involvement in the Made For Ministries, Inc. sober living community program.  I am eighteen (18) years of age or older, and this RELEASE is binding on me and my executor, administrators, and heirs. I have fully read and understand the above RELEASE. *

Signature:

Date: