Life Institute Application
Victory Mission’s new Life Institute is an outreach of Victory Mission + Ministry. Through this ministry we want to provide a safe and supportive environment for individuals to engage in life restoring classes and services.

Through all of our services and programming at Victory Mission, it is our intention to live out our commitment to sharing God’s love through intentional relationships and opportunities for life restoration. We want to do more than sustain you in a difficult situation. We want to offer opportunities, resources, and support to help you transform your life and live out of your true God-given value and purpose.

To help provide opportunities for holistic healing in your life through Victory Life Institute, we will invite you to share with us openly about your unique situation and to fully participate in classes, case management, and counseling services offered free of charge. Evening classes will be followed by a healthy meal.

We will offer classes in the following holistic areas:
Personal | Relational | Vocational | Spiritual | Financial

Life Institute Classes for participants will take place on at Victory Mission’s administrative building on
Monday - Thursday nights on an 8-week rotation with the following evening schedule:

4:30 - Chaplain Check In
5:00 - Classes Start
6:00 - Dinner Distributed

All interested in applying to the Life Institute must be willing to fully participate in the following:
Interview for the program
Attend evening classes
Meet with a VM case manager
Meet with a VM counseling intern

Behavior that harms others or puts others or staff at risk will not be tolerated. To help provide a safe and healthy environment, the following types of behaviors (partial list) will not be tolerated:
Intoxication/Under the Influence of Drugs, Abusive Language/Profanity, Panhandling, Making False Accusations, Assault/Attempted Assault, Theft/Possession of Stolen Goods, Entry in Unauthorized Areas of the Building, Vandalism/Defacing Property, Any Illegal Transaction, Verbal/Physical Intimidation, Any Sexual Misconduct, Smoking Outside Designated Area, and Weapons (weapons may be checked in with security).

Programming will adhere to guidelines to help reduce risks of COVID-19 spread in the community. You will be asked to wear a mask, participate in a temperature check, maintain the recommended 6 ft. social distancing, and do all that you can to protect yourself and those around you from the spread of disease.

If you are interested in being a part of the new Life Institute, please fill out an application (in its entirety). A chaplain will reach out to you if you have been admitted to this life-changing program!
I have read and understood the statement above: *
Personal
First Name (Legal) *
Last Name (Legal) *
Preferred Name (if different than Legal)
Date of Birth *
MM
/
DD
/
YYYY
Contact Address *
Email Address
Contact Phone *
Best Way to Contact You? *
Required
Romantic Relationship Status *
Child(ren)/Age(s)
Emergency Contact Name (First & Last) *
Emergency Contact Phone # *
Emergency Contact Relationship *
Do you have a photo ID? *
Have you ever been barred/suspended from Victory Mission (this will not necessarily keep you from attending)? *
Medical
Have you ever had a mental health diagnosis or treatments? *
If yes, what is your mental health diagnosis (and when were you diagnosed)?
Are you currently taking any medications? *
What medications, if any, are you taking?
Legal
Are any of these legal situations applicable (check all that apply)? *
Required
If you answered yes to any of the legal questions or have any other current legal issues, please share details.
Substance Abuse
Do you have a history of any of the following (check any that might apply)? *
Required
If you answered yes to any of the situations above, please tell us a bit more about your journey of healing.
Spiritual
Please describe your current/past experience with faith, church, or religion of any kind. *
Are you currently consistently involved with a faith community? *
If you currently attend a faith community, which one do you attend? How are you involved with your church?
Personal Situation
Rate Your Current Overall Situation *
Worst Situation Possible
Best Situation Imaginable
Please tell us a little bit about the situation you are facing right now. *
FOOD ACCESS (best description) *
HOUSING SITUATION (best description) *
TRANSPORTATION (best description) *
EMPLOYMENT (best description) *
INCOME/BUDGET (best description) *
Household Monthly Income Amount (including SSI/SSDI, Child Support income, etc.): *
PERSONAL & COMMUNITY SUPPORT (best description) *
COMMUNITY INVOLVEMENT (best description) *
EDUCATION (best description) *
MENTAL HEALTH/ SUBSTANCE ABUSE (best description) *
PHYSICAL HEALTH (best description) *
PSYCHOSOCIAL/ENVIRONMENTAL STRESSORS (best description)
Clear selection
I receive the following supportive government benefits (check all that apply): *
Required
Is there anything we can pray for you about or anything you would like us to know?
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