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Genesis Project Participant Application
The Genesis Project is a faith-based residential growth program for vulnerable single mothers.
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* Indicates required question
Name
*
First and last name
Your answer
Email
*
Your answer
Phone number
*
Your answer
Birth date
*
MM
/
DD
/
YYYY
Current Address
Your answer
What is your living arrangement?
Shelter
Couch Surfing
Friends
Family
Apartment
House
Homeless
Car
Are you safe?
Yes
No
Clear selection
What is your latest completed level in school?
Middle School
Junior High
High School
GED
Associates
Bachelor's Degree
Master's Degree
Voacational Certificate
Do you receive any of the following? Check all that apply
TANF
Food Stamps
WIC
Child Support
Medicaid
Gifts from family/friends
Alimony
Are you employed?
Yes
No
Clear selection
How many children are in your custody?
Your answer
Child's age (mark all that apply)
**Children over the age of 13 cannot reside at Genesis Project**
1
2
3
4
5
6
7
8
9
10
11
12
13+
infant
pregnant
Are your children in foster care?
Yes
No
Both
Clear selection
Are you a victim of domestic violence?
Yes
No
Clear selection
Are you aware that we are a drug (including marijuana), alcohol, tobacco and vape free home?
Yes
No
Clear selection
Are you willing to remain single if accepted into the program?
Yes
No
Maybe
Clear selection
Are you aware that we are a Christian organization?
Yes
No
Clear selection
How did you hear about the Genesis Project?
Your answer
Submit
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