Hungry For God Home
Hungry For God Home
Hungry For God Home
Hungry For God Home
If you are or know a young man that is coming out of juvenile crime, aging out of a foster home, have run away from home,or have at-risk behavior, we can help. please fill out the form below and click "send". Pastor Larry will be in touch with you soon.

We can do the following for you:
Provide Life Skills and Independent Living Assistance
Provide Healthy and Nutritional Disciplines, Positive Outcomes
Mentoring Relationship, Fatherhood Building and Social Skills
Involvement in Community Volunteerism and Awareness
Faith-Based Spiritual Values/Coaching through Daily Chapel/Course participation


Entry Levels
1. Temporary Housing - 1-30 days (start Evaluation daily, start History daily, possibly some Training,some Outcomes documented, Follow Up discussed)
2. Mentoring Discipleship - 20-30 days (Evaluations daily, History daily, Training daily, Outcomes documented with Application, Follow up outlined)
3. Intern Mentoring Discipleship - 30 days-1 year (Evaluation weekly, History near completion to completed, Training being acquired, Outcomes documented with Application, Follow Up outlined) 4. Leadership Internship/Volunteerism - 3 years (Evaluation monthly, History completed, Training degree/certiļ¬ed, Outcomes documented with Application Giving back to community, Follow Up method outlined Evaluate for full time Staff)

ALL INFORMATION IS CONSIDERED CONFIDENTIAL. NONE OF YOUR PERSONAL INFORMATION WILL BE SHARED WITH ANYONE ELSE, UNDER ANY CIRCUMSTANCES. WE ALSO HAVE A NON-DESCRIMINATION POLICY. THESE QUESTIONS MAY SEEM PERSONAL, BUT THEY ARE IMPORTANT SO WE WILL KNOW YOUR CIRCUMSTANCES, AND CAN TAKE APPROPRIATE ACTION.
Hungry For God Home

Name:
Email:
Address:
City:
State:
ZIP:
Phone Number:
Age:
DOB:


Hungry For God Home

Father? No Yes
Mother? No Yes
Marital Status
Children:


Hungry For God Home

Church? No Yes
Address:
City:
State:
ZIP:
Phone Number:
Website:
Denomination:
What Activities Have You Been Involved In At Church?:


Hungry For God Home

Health: Poor Fair Good Excellent
Physical Limitations:
Physical Concerns:
Allergies:
Medication:
Tuberculosis Never Have Now Have had
Hepatitis A Never Have Now Have had
Hepatitis B Never Have Now Have had
Hepatitis C Never Have Now Have had
HIV Positive Never Have Now Have had
Herpes Never Have Now Have had
Veneral Disease Never Have Now Have had
Lice Never Have Now Have had
Can You Lift 25 LBs? No Yes
Can climb 4 stair flights? No Yes


Hungry For God Home

Alcohol Never Use Now Have Used
Barbiturates Never Use Now Have Used
Cocaine Never Use Now Have Used
Heroin Never Use Now Have Used
Marijuana Never Use Now Have Used
Meth Never Use Now Have Used
Speed Never Use Now Have Used
LSD Never Use Now Have Used
PCP Never Use Now Have Used
Prescription Abuse Never Now Have Abused
Other Drugs


Hungry For God Home

Smoking? No Yes
Anger? No Yes
Violence? No Yes
Athority Conflicts? No Yes
Homosexuality? No Yes
Low Self-Esteem? No Yes
Child Abuse? No Yes
The Occult? No Yes
Co-Dependency? No Yes
Arrest/probation? No Yes
Sexual Immorality? No Yes
Pornography? No Yes
Personal Discipline Problems? No Yes
High School:
School Name:
City:
State:
Date Enrolled:
College:
College Name:
City:
State:
Date Enrolled:
Trade School:
Trade School Name:
City:
State:
Date Enrolled:
Have You Ever Been Dropped or Expelled From school or Treatment Program? No Yes
If Yes, Then Why?
Do You Own A Car? No Yes
Have You Done Jail Time? No Yes
Are You On Probation/Parole? No Yes
Parole Officer Name:
Parole Officer State:
Parole Officer Phone:
Do Currently Have Pending Legal Charges, or Warrents? No Yes


Hungry For God Home

Were You Raised In A Christian Home? No Yes
If No, Which Religion?
If yes, please brefiely describe your conversion experiance


Hungry For God Home

Brefiely explain why you would like to attednd Hungry For God Home for Young Men:
Brefiely describe your long term goals:
Security Question:
Thank you for filling out this form. Pastor Larry will recieve this information, and contact your shortly.