The Dresden House
Transitional Housing Application
MUST HAVE A CERTIFIED BIRTH CERTIFICATE
PRIOR TO ENTRY TO OUR PROGRAM!!!
The Dresden
House Transitional Housing Program located near Sedalia, Missouri is a Christ
centered program addressing hurts, habits and hang-ups from a Biblical
standpoint. Applicants must be willing
to participate fully in this program from a spiritual stance and abide by ALL
program guidelines.
Please complete all
information on this form. If you need
additional space, please use the back of this form. All of your answers and information will be
kept confidential.
Name: D.O.C. #:
Date of Birth: / / Social Security #:
Are you a
veteran? Yes No Honorably Discharged? Yes No
Marital Status: Married Single Divorced Widowed (please circle one)
Name of spouse or
ex-spouse Tell us a little about the situation:
Are you in a committed “romantic” relationship? Yes No If yes, how long?
Do you feel it is a
healthy relationship? Yes No Why?
Do you have children? Yes No If yes, how many?
Do you have a
relationship with your children?
Have you ever been
incarcerated? YES NO How
much time has you served?
DOC Address:
Do you have a violent offenses: YES NO Do you have a sex related offenses: YES NO
Name & location
of current Probation/Parole Officer/Case Worker:
Are there any
special circumstances regarding your Probation/Parole?
What county are you supposed to parole to:
What county were you convicted in?
What county is your home plan supposed to be in?
List all convictions
past and present and how much time served with each one. (Please be very
specific. We need to know this information so we can work with Probation and
Parole on your behalf). Please list
dates if you can remember them):
a. b.
c. d.
Past drug or alcohol use? YES NO
Have you ever been in a drug or alcohol treatment program? YES NO If yes, date: _____________
If you were in a
program before, what is different about you or your circumstances now?
Are you taking prescription
medication? YES NO Last
Doctor’s visit for medication?
What is the
medication for?
What is the name(s)
of the medication(s) you take?
Do you have any
other health issues? YES NO If yes, please explain:
Have you ever been admitted to a mental facility or a mental treatment program? YES NO
If yes, where and how long?
What is your
religious background?
What denominations
do you follow?
Do you see God as a
part of your life? If yes please explain:
Past work experience:
What new things have
you learned about yourself while you were incarcerated?
What did you like
about incarceration?
What do you least
like about being incarcerated?
List some things you
are hoping to get out of The Dresden House Transitional Housing Program?
Why did you choose
this program?
List three
short-term goals for yourself (next six months):
List three mid-term
goals for yourself: (next 1-3 years)
Any other
information that you think might be helpful so that we can serve you better:
Emergency contacts:
(This is for emergency use only) Name: Relationship:
Address:
City/State:
Zip: Phone: ( )
Please send your
completed application to:
Mail: The Dresden House Transitional Housing Program
PO Box 1105
Sedalia, MO 65302-1105
Fax: 660-826-4410
Email: a_redeemed_1@yahoo.com
In order to be considered for entry into our home, you must
have a completed application submitted and processed by our office and our
local Probation and Parole or law enforcement office. You will receive written determination from
us within 30 days. If immediate
processing is required, please let us know.
PROCEDURE FOR ENTRY
Ř
The Dresden House Transitional Housing Program is a voluntary program. Applications will only be approved from people
who are committed to a life change. All
applicants must be between the ages of 18 and 60 years of age to be considered
for admission.
Ř
Applicants
must be physically able and mentally stable to participate in all work and
living situations.
Ř
No
person will be admitted to the program that is currently taking psychotropic
medications.
Ř
Applications
from sexual and violent offenders will not be approved.
The Dresden House Transitional Housing Program
Agreement
Upon acceptance into The Dresden House Transitional Housing Program, you become a member of the Dresden House Transitional Housing Program Family.
To enable The Dresden House to provide the transitional housing program and accommodations to people seeking help, shared living expenses of $125 per week are required from each family member. The Dresden House Transitional Housing Program volunteers and staff will assist you in finding employment, but it is your responsibility to continue to apply for jobs until work is found. Shared living expenses help cover the cost of accommodations, food, laundry, phone, television, utilities, access to approved social services, parking, personal storage (limited) and local transportation to church, treatment centers and social services. Residents are responsible for the purchase of toiletries, personal items, and clothing.
All policies are
subject to change at the discretion of the Program Directors.
I have read entire The Dresden House Transitional Housing agreement contained herein. I understand the terms and conditions of The Dresden House Transitional Housing Program that are detailed in this application agreement. I agree to follow the terms and conditions of The Dresden House Transitional Housing Program. I understand that I am a member of The Dresden House Transitional Housing Program Ministries’ Family and as such, shared living expenses are not rent, and this is not a tenancy agreement. I have completed the application to the best of my ability.
I understand and agree that any information knowingly given to be false
is grounds for immediate expulsion from The Dresden House Transitional Housing Program.
Family Member Agrees:
Date:
Name:
Signature: