Kairos Hope Intake Form
The following intake form will be kept confidential within Kairos Hope organization. Answer each question honestly and to the best of your ability.
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Email *
First Name *
Last Name *
Nickname (Preferred Name)
Date of Birth *
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DD
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Applicant's Phone Number *
Mailing Address or Name of Shelter *
Country Of Birth *
Are you a U.S. Citizen? *
Do you have a court-appointed legal guardian? *
How did you hear about Kairos Hope? *
Why are you applying to Kairos Hope? *
Do you wish to complete any of the following at Kairos Hope?
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What are your goals and expectations of coming to Kairos Hope? *
When are you hoping to be accepted by? *
After we receive your application, we do a brief phone interview. What days of the week or time of day works best for you? Is there a day and time this week that would work great for you? *
At Kairos Hope you will be expected to participate in Bible Study, Life Skills Classes, and Fitness Classes. Are you willing to participate in these activities while at Kairos Hope? *
While in the program at Kairos Hope you are not allowed to use any recreational substances including vapes, cigarettes, and weed. By marking "I agree" you state that you understand this policy and will abide by it. *
Kairos Hope is a 6-9 month recovery program. We are not a shelter. Therefore we have high expectations to help push you to grow. Please explain why you feel you are ready for a recovery program? *
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