Kairos Hope Resident Application

Welcome to the Kairos Hope Resident Application. We are dedicated to providing a safe and supportive environment for survivors of sexual trauma. Our residential recovery home offers comprehensive care, including therapeutic services, life skills training, and community support to help residents heal and rebuild their lives.

Please complete this application with as much detail as possible. Your information will be kept confidential and used solely to determine eligibility and tailor our support to your needs. We look forward to the opportunity to support you on your journey to recovery and empowerment.

Application Instructions:

  • Ensure all sections are filled out accurately.
  • If you have any questions or need assistance, please contact our admissions team at info@kairoshope.org.

Thank you for considering Kairos Hope. Your healing journey is important to us.

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What is your full name?
What is your date of birth?
What email can we contact you at
This is our primary form of contact so be sure it is one you can access.
What is a good phone number to reach you at?
Please mark each of the following that is true for you.
At Kairos Hope we tailor your treatment to your specific needs. Please mark which of the following are true for you so that we can begin formulating a plan. These do not automatically disqualify you.
Do you have any medical limitations or ongoing medical concerns? If so, explain.
What medications are currently prescribed to you?
Why do you think Kairos Hope is a good fit for you and what do you hope to gain while at Kairos Hope?
One of the most important factors for acceptance into our program is your commitment to personal growth and healing. This section is your chance to share with our review team why you believe you are a good fit for Kairos Hope and what you hope to achieve during your time with us. Your honest and thoughtful responses will help us understand your needs and how we can best support you on your journey to recovery.
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