Stay Free Ministries Entry Assessment - Women's Program

NOTICE: If you leave or are dismissed from the program and choose to return, there will be a $200 re-entry fee. No exceptions.

Thank you for your interest in entering the Stay Free Ministries Discipleship Program. Our mission is to reach out and raise up by offering you the path to salvation, transformation, and restoration through the love and ministry of Jesus Christ. Our vision is to see lives changed, families restored, and men and women become the leaders in their homes, churches, and communities. We are aiding individuals in redirecting their lives by using God's values and principles. Classes are structured to teach men and women to take responsibility for themselves, and for others, while allowing God to reshape their lives.

2 Corinthians 5:17 "Therefore, if anyone is in Christ, he is a new creation. The old has passed away; behold, the new has come." (ESV)

This entry assessment form must be completed and submitted. Once received, your application will be prayerfully reviewed. You will be contacted as soon as possible to let you know if you have been accepted into the program or placed on a wait list.

*If you are placed on a wait list, you must contact us every week so that we know you are still interested in the program. If you do not contact us each week, we will remove your name from the wait list.

Please keep your affairs in order. We never know when a bed may become available. When you are contacted, your bed will only be on hold for 24 hours. No exceptions.

Application Date

Month

Day

Year

Date of Birth

Month

Day

Year

Please list two ways of contacting you: (Personal Reference, Phone number, Email, Address)

In a brief paragraph, please explain why you should be accepted into our program.

Have you previously been a resident in our discipleship home at SFM?

Yes

If yes, please explain the circumstances under which you left or were dismissed:

Have you ever been in a long term Christian discipleship home?

Yes

Are you willing to spend 12 months in a residential discipleship program?

Yes

Can you read and write?

Yes

Some

Are you willing to have a background check?

Yes

If you're not willing to have a background check, please explain why:

What is your drug of choice? (if any)

Do you need to detox?

Yes

Maybe

Are you incarcerated?

Yes

If yes, where are you incarcerated?

Are you ordered or referred by the court to enter the SFM program?

Yes

If yes, list the name(s) and contact information of the court, county, judge, or officer of the court who ordered/referred you:

Are you on probation or parole?

Yes

If yes, please provide the county, state, probation officer's name, phone number, and address/email/fax:

Have you ever been convicted of a sexual offense or do you currently have sexual charges pending? Please explain.

Are you a registered sex offender? Explain.

Are you currently or do you feel that you need to be on psychiatric medication?

Yes

Maybe

Do you have any warrants? Please explain.

Please provide any and all past or current arrest cases (Charge, Date, County, Court Date):

Do you have an attorney? Please list name and phone number. If no, type "NO"

*We do not act as your lawyer. If you are in jail, you will need your lawyer to do any legal work for you. We are not able to provide transportation from jail. Your lawyer may contact Pastor Rick Laster at 256-200-1056 for further information.

What else is currently happening in your life?

Family Member #1 name and contact information:

Family Member #2 name and contact information:

Do you have a government issued photo ID or drivers license?

Yes

*Residents must obtain an ID within 30 days of admission to the program.

If you do not have a driver's license, please list conditions that have to be met to restore driver's license.

Do you have a social security card?

Yes

If you do not have a social security card, please list the actions that must be taken to obtain one.

How did you hear about us?