Holland House Admission Interest Form
Below are a few details about Holland House
Operation Hours
Monday-Thursday
8:30 A.M.- 3 P.M.
1132 Country Club Rd. Metropolis, IL 62960
-Rolling in Faith is not responsible for transportation to and from program.
Fees
$320/mo.
Payment plans can be scheduled semesterly or monthly.
-One time application fee: $200 due two weeks after application is submitted.
Checks to be made to 'Holland House'
-Financial aid may be available for some situations

Regulations
Rolling in Faith's Holland House shall accept only young adults (18+ or those who have graduated/aged out of high school), whose capabilities enable them to benefit from the program, and for those both programs are staffed and equipped to provide care.​ Rolling in Faith & the Holland House program do not tolerate bullying, self-harm, or dangerous behavior. Holland House shall not admit or maintain any young adult whose needs it cannot meet or whose behavior would be dangerous for other students in the program.

* Rolling in Faith's Holland House is an independent organization and does not accept the Medicaid Waiver at this time. *
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Email
Your (Parent/Guardian) Name *
Parent/Guardian Phone Number *
Participant's Name *
Participant's Diagnosis *
How did you hear about Holland House? *
What is participant's birthdate? *
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DD
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Where did/does participant attend high school? *
Is your participant independent in regard to activities of daily living? (i.e., toileting, eating, etc.) *
Please describe your participant's level of independence in regard to independent living skills (Ex: appropriate conversation, social cues, problem solving, levels of independence, how they help around the home, etc.) *
Does your participant have any behaviors we should be aware of? *
Would your family need to apply for Tuition Assistance? *
 To schedule a participant interview, what days of the week work best for you? These will begin in April-May 2023. *
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