Application for Residency 9 mo

Application FOR RESIDENCE

Please Note: We encourage all potential applicants to watch our “Get Set Free” video on the front page of our site prior to filling out the application below. We also ask that the application be filled out by the applicant. Any application completed by someone else will not be allocated. Filling out your own application is a pre-requisite for program admittance.

9 Month Application For Residency

Referral Source:

Name:

Full Address (Please Include: City, State, and Zip):

Phone #: *

Age:

DOB:

Sex:

Race:

Approx. Height:

Approx. Weight:

Sexual Preference:

Marital Status: Single/Married/Separated/Divorced/Widowed

Children - Yes or No? - How Many?:

How much do you pay weekly for Child Support?:

Emergency Contact Name:

Emergency Contact Phone:

Are you a U.S. Citizen?:

Do you have a SSC card?

Do You Have an ID - is it Valid?:

Highest Level of Education:

Can you read and write English:

Trade or work experience:

Do you receive any types of Government benefits?:

Medical Conditions (Please explain):

Current Medications (including non-narcotics i.e. antidepressants, sleep aids, mood stabilizers etc.):

Serious, Chronic, Current Illness or Disability (any physical problems that hinder you from working):

Have you ever been diagnosed as Bi-Polar, Manic Depressant, Schizophrenia or any other Mental Disorders? If so, please explain:

Addiction History (Please include Start Age, Drug of Choice, and Date of Last Use):

Current Criminal Charges? If so please explain and include case #'s:

Criminal Charges in the Past?:

Are you a Registered Sex Offender or Predator? (Please note this will make you ineligible for our program):

Please give us an overview of your background in regards to church and any denomination you might have been raised in:

Do not assume anything. If you have a question, ask:

Be willing to do whatever it takes to get free and stay free:

Observe proper language at all times. No war stories (stories of the past):

Submit to all authority and respect one another in all things:

Be willing to commit to a minimum of 9 month residential with a one year aftercare (attendance of two functions or services per week). Please note: If you're court ordered, aftercare is mandatory:

Be willing to give your all, with complete 100% honesty:

Follow all guidelines posted in the house and given by the elders:

Do not borrow from others without permission from the office:

Do not pursue relationships with the opposite sex (marriages excluded) -No same sex relationships or marriages permitted:

Attend, be on time, sit up, be prepared, take notes, and participate at every function and class:

No food or drink during teachings or class:

Do not have in your possessions: Cigarettes, Alcohol, Illegal Drugs, Prescription Medication (unless approved by staff), unauthorized magazines/books, secular music, or any clothing or items that have alcohol, cigarette, or other demonic logos or sayings:

Be willing to move to any house on the campus at any time, as directed by the staff:

Do not participate with: drugs, cigarettes, sexual reading or activity, fighting, threats of violence, stealing & gambling, etc. on or off campus:

Do not leave campus without permission from an elder. If you leave and do not come back within 24 hours to collect your belongings, Total Freedom will no longer be responsible for them. You will lose all possessions and savings:

Complete all assignments and house duties on time:

Keep bedroom clean and house in order:

Do not watch T.V. or use the telephone unless approved by an elder:

At the discretion of the Director, you will be eligible to find empoyment. Once employed, you are required to contribute $145 wk as contribution to the ministry for your care. Also, 10% of your gross pay will be submitted as an offering to True Ministries Church. You must maintain a $600 balance in your savings account. Groceries, transportation, and medical costs may be taken as required.

Waive all rights to pursue any legal action against Total Freedom, True Ministries, Vine of Life Ministries, or any staff / personnel associated with our organization. We are not responsible for any accident or injury you may sustain while enrolled in our program.

If you do not complete the program, you will be charged $145 wk for the first couple months until you've obtained employment and start to contribute financially. Upon leaving/removal that amount will be deducted from the overall amount in your account.

Failure to comply with this contract can result in a disciplinary actions, restriction, fine, or termination from the program.

Why do you want this program?

Signing here means that you've filled out the application 100% on your own and have had no assistance in doing so. Please Note: This is part of how we determine if an individual is eligible for the program, we will not consider this a valid application unless filled out by the applicant themselves.

Signing here means that you've read and will cooperate with all stipulations pertaining to our program listed on this application.

If you are human, leave this field blank.