Application for Hope Ministries of Northeast Texas
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 address *
Date of Application
MM
/
DD
/
YYYY
Name - First, Middle Initial, Last
Your answer
Contact Phone Number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Marital Status *
How did you hear about Hope? *
Your answer
Briefly tell tell us your story that has led you to Hope? *
Your answer
If you are accepted in Hope what are your top 3 goals? *
Your answer
Will your children be joining you at Hope? *
How many children do you have? *
Your answer
What are the names, dates of birth, gender, and ages of your children?
Your answer
Have you ever had a CPS case? *
When was the case opened/closed? Is it still active?Please give details.
Your answer
Did you graduate from High School?
If no, what is the highest grade you completed?
Have you attended technical school or college?
If yes, where? and when?
Your answer
Are you currently employed?
If yes, where are you currently employed?
Your answer
What is your current rate of pay?
Your answer
How long have you worked for this employer?
Your answer
If you are not employed, are you actively seeking employment?
What is your current income - including jobs, child support, food stamps, and other sources of income?
Your answer
How much do you owe in debts? Include medical bills and student loans
Your answer
Have you been arrested in the past
If yes, please list dates, charges, disposition and explanation
Your answer
Do you have a felony conviction? (this does NOT affect your eligibility for Hope Ministries)
If yes, please tell us about it
Your answer
Are you currently on parole or probation?
If yes, for what charge?
Your answer
Please list any current or recurring medical problems
Your answer
Please list any medications you are taking
Your answer
Please list any conditions and medications for your children
Your answer
Do your children have Medicaid?
Have you ever been diagnosed with mental illnes?
If yes, please tell us about it. include dates, treatment, and medications
Your answer
When was the last time you used drugs or alcohol?
Your answer
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
Your answer
Which church do you attend ?
Your answer
Who is your pastor?
Your answer
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
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Hope Ministries of North East Texas. Report Abuse - Terms of Service