Initial Application - RLMO
The men who are admitted to our program are first interviewed by the director. Director will go over rules and regulations and make a determination of an applicant's readiness to attend RLMO's program. Please complete all information below and our team will be in touch for initial phone consultation. Thank you for your interest in our program.
Name *
Your answer
Email *
Your answer
Current Address *
Your answer
County *
Your answer
Phone number *
Your answer
What treatment programs have you previously attended? Did you complete them? *
Your answer
Family member contact name *
Your answer
Family contact relation *
Your answer
Family contact phone number *
Your answer
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This form was created inside of Renewed Life Ministry Outreach.