Stay Free Ministries Entry Assessment - Family Matters

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

Intake Policy: Are you a candidate to be a Family Matters Client?

Women coming from prison, jail, court ordered or DHR referrals (released from prison or jail within the past 6 months)
Women struggling with addiction or women coming from abuse.

If she (applicant) is one of the above, she must fit the following criteria:

Above the age of 18
Children 10 & under are welcome to live with their mother after completing phase 1 & upon room availability
Is not a registered sex offender
Does not take any medications
Must be completely mobile
If disabled, must be on disability
If not disabled, must be able to hold a full time job

Once you have confirmed you are a candidate for SFM Family Matters, please complete the remaining application.

The Family Matters program is to serve women and children of our community, meeting their physical and spiritual needs as well as equipping them with life skills and parenting tools to walk through motherhood with confidence and commitment.

Our mission statement is “supporting families through life-altering situations and rebuilding their lives on a solid, Godly, and ethical foundation.”

Stay Free Ministries offers many different classes to students, which include: Inner Healing (digging deep to heal those wounds of past trauma), Cultivate class ( building disciples to further Gods kingdom), and Relapse prevention: making us aware of the triggers and the biblical strategies to come against those triggers. We also offer a 7 week parenting class called “ Families Count” which is offered once a year and is court and DHR accredited.

Please note: that SFM Family Matters is a all female facility. You must identify as a female and have the anatomy of a female.

Application Date

Month

Day

Year

Date of Birth

Month

Day

Year

Address (If currently unhoused, that's okay. Just write "unhoused")

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

How did you hear about the Stay Free Family Matters Program?

Have you previously been a resident in Family Matters or the SFM Women's Program?

Yes

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

Have you previously been a resident in Family Matters or the SFM Women's Program?

Yes

Do you have a birth certificate?

Yes

Do you have a social security card?

Yes

Do you have children that will reside with you at SFM Family Matters?

Yes

Children Policy: SFM Family Matters accepts children up to 10. We find that it is very important for clients to complete the probationary period (average of 30 days) before having a child(ren) enter into the facility with their mother. We are aware that there are some urgent cases and children have nowhere safe to go. If that is the case it will be determined on case by case basis.

Select "yes" if you understand

Yes

I have questions

If you have children planning to reside with you, how many and what are their dates of birth?

Do you have your child(ren)'s social security card or number?

Yes

Does your child(ren) have Insurance or Medicaid?

Yes

Are you required by a judge to complete a program?

Yes

If required by a judge to complete a program, list the judge, phone number, and county.

Legal Information: Please list and EOS date and name & contact information for the Probation/Parole Officer, CRO, DHR Social Worker or Community Corrections Officer.

Are you currently in active addiction?

Yes

If you are currently in active addiction, what is your primary drug of choice?

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.

Do you have any warrants? Please explain.

What else is currently happening in your life?

Please explain why you're applying to be in the Family Matters program. What brings you here?