New Life Program - Client Application
Modesto Gospel Mission 18-month New Life Program Application
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Than you for your interest in the Modesto Gospel Mission's New Life Program
The Modesto Gospel Mission's New Life Program is intended to bring about an orderly and reasonable sequence of events to bring men and women to spiritual freedom and successful independent living. It is the goal of this program to apply biblical principals to the process of overcoming undesirable behaviors and develop desirable behaviors in the lives of the men and women enrolled as Disciples.

This is accomplished through seven areas of development: Spiritual, Physical, Emotional, Social, Educational, Financial, and Employment - which will be addressed through Christian counseling, biblical studies, educational enrichment, and physical work.

A certificate of completion is awarded for each phase or step, after which the participant may apply to the next phase or step.

We pray your stay here will be one of transformation into the new life that God has for you through Jesus Christ.
Name *
AKA
Phone Number *
Are you in Freedom Road Day Program? *
Marital Status *
Required
Are you physically or emotionally involved in a relationship? *
Date of Birth *
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DD
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Place of Birth *
State *
SS# *
CA Driver's License or ID# *
Do you have children? *
Child's name, DOB, and sex (if applicable)
Where are your children (if applicable)?
Who has custody of your children (if applicable)?
Do you have visitation rights (if applicable)?
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Emergency contact *
How do you know your emergency contact? *
Address (emergency contact) *
Phone Number (emergency contact) *
City (emergency contact) *
State (emergency contact) *
Zip Code (emergency contact)
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