Online Application for Hope Ministries of NET
 Application for Hope Ministries part 1 - Once you submit this applicant inquiry you will be contacted.  After a phone interview you will be asked to complete a more detailed application.   
Email *
We encourage you read our Application Requirements (Covenant for Change) to make sure Hope is the right place for you. Please indicate below if you have competed this step. *
Date of Application
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Name - First, Middle Initial, Last
Contact Phone Number *
Date of Birth *
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Marital Status *
How did  you hear about Hope? *
Briefly tell tell us your story that has led you to Hope? *
If you are accepted in Hope what are your top 3 goals? *
Will your children be joining you at Hope? *
How many children do you have? *
What are the names, dates of birth, gender, and ages of your children?
Have you ever had a CPS case? *
When was the case opened/closed? Is it still active?Please give details.
Did you graduate from High School?
Clear selection
If no, what is the highest grade you completed?
Clear selection
Have you attended technical school or college?
Clear selection
If yes, where? and when?
Are you currently employed?
Clear selection
If yes, where are  you currently employed?
What is your current rate of pay?
How long have you worked for this employer?
If you are not employed, are you actively seeking employment?
Clear selection
What is your current income - including jobs, child support, food stamps, and other sources of income?
How much do you owe in debts? Include medical bills and student loans
Have you been arrested in the past
Clear selection
If yes, please list dates, charges, disposition and explanation
Do you have a felony conviction? (this does NOT affect your eligibility for Hope Ministries)
Clear selection
If yes, please tell us about it
Are you currently on parole or probation?
Clear selection
If yes, for what charge?
Please list any current or recurring medical problems
Please list any medications you are taking
Please list any conditions and medications for your children
Do your children have Medicaid?
Clear selection
Have you ever been diagnosed with mental illnes?
Clear selection
If yes, please tell us about it. include dates, treatment, and medications
When was the last time you used drugs or alcohol?
Do you have a history of substance abuse? *
Have ever been admitted to rehab for any addiction or behavior disorder that required inpatient treatment and care? *
If yes, please share the details - include dates
Which church do you attend ?
Who is your pastor?
Do you have a Sponsor, Church or Pastor that will be helping you enter Hope Ministries? If so, please submit name and contact information. *
Thank you for taking the time to fill out this application. We are praying for you!  By submitting this application you agree for Hope Ministries to contact you. Additionally, you agree and verify that you are filling out this application for yourself and are doing so by your own free will and that you desire transformation and change.  What is the best time and phone number for us to call you? Please list an alternate number that we have your permission to contact, as well
*Applicants are interviewed in a process and admitted in date order. Please be aware that we are not emergency relief and that there may be a waiting list with other applicants before yours. *
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