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House expectations & Applicant information
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* Indicates required question
Email
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Your email
Full Name: First, Middle, Last
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Your answer
Current Home Address
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Your answer
Phone number
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Your answer
House Expectations:
Expectation page #1:
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I have read and understand expectations on this page.
Expectation page #2:
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I read and understand expectations on this page.
Expectation page #3:
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I have read and understand expectations on this page.
Expectations Page 4:
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I have read and understand expectations on this page.
Expectations Page 5:
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I have read and understand expectations on this page.
Expectations Page 6:
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I have read and understand expectations on this page.
Expectations Page 7:
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I have read and understand expectations on this page.
Describe our current situation.
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Your answer
Are you a sex offender?
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Yes
No
How did you hear about Grace Recovery Ministries
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Your answer
(1) References, not in prison
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Full Name, Address, City, State, Phone, Relationship
Your answer
(2) References, not in prison
Full Name, Address, City, State, Phone, Relationship
Your answer
Can you pay the initial first months Fee? If yes explain.
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Your answer
Do you have any children? If yes explain your relationship with them and their mother (guardian)
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Your answer
Do you have any pending charges, if so explain.
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Your answer
Is there an order of protection against you in the state of Missouri?
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Your answer
Are you currently on any prescribed medication?
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Not that anyone who is heavily medicated due to psychological issues need not apply. We are not a medical center and cannot accept this type of client.
Your answer
When was the last time you used drugs, or alcohol or any other medication prescribed by a doctor?
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Your answer
Are you in a romantic relationship or any kind, including emotional? If yes please explain.
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Your answer
Do you consent to a background check?
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Yes
No
Is there anything on your background check that we need to be aware of?
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Your answer
A copy of your responses will be emailed to the address you provided.
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