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A Ministry of Arizona Baptist Children's Services
A Ministry of ABCS
Arizona Baptist Children's Services
Arms of Love Foster Care & Parent Aide
Community Resource Centers
Mission Encounter 360
New Life Counseling
New Life Pregnancy Center
New Life Transitional Program
Pursue Life Adult Ministry
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APPLICATION
Supportive Housing Client Application
Application for Arms of Love Home
Step
1
of
4
25%
Personal and Contact Information
Name
*
First
Last
Nickname:
Date of Birth
*
Month
Day
Year
Age:
*
Please enter a number from
16
to
22
.
Phone #
*
Social Media Handles:
Email
*
Enter Email
Confirm Email
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
How long have you lived at your current address?
*
When did you enter foster care?
Case Manager & Contact Info
*
What is your spiritual/religious background?
*
Are you a member of a local church/congregation?
*
Yes
No
Name of congregation:
What do you like to do in your spare time?
*
What three words would you use to describe yourself?
*
How did you learn about the Arms of Love Home?
Why do you believe that you should be chosen as a resident of this home?
*
What are some specific goals you have for the next 6 months, 1 year and 3 years?
*
How would you use this program to assist you in achieving these goals?
*
Health History
Check the box if your answer is YES:
*
Have you received counseling or treatment before?
Have you been treated for harm to self or others?
Do you smoke/vape?
Have you been pregnant before?
Do you use tobacco substances?
Do you take marijuana for recreational or medicinal purposes?
Do you have a medical marijuana card?
Have you used drugs before?
Have you been in a 12-step or recovery program before?
Have you been in or associated with a gang before?
Have you been on probation before?
Have you been arrested or jailed?
Have you been diagnosed with a medical condition/illness?
Have you been diagnosed with a form of mental illness/condition?
Have you taken medicine for a mental or emotional condition?
None of these apply
If yes, please describe below:
List all medication below:
*
Career Readiness
Have you completed high school or GED?
*
Yes
No
Are you enrolled in the DCS Young Adult Program?
*
Yes
No
How much is your monthly stipend?
Please enter a number less than or equal to
800
.
If you are currently employed, where?
If employed what is your monthly earnings?
Please list any other monthly income and your plans to support yourself:
List your most recent volunteer experience:
List your most recent employer:
Name of Employer:
City/State
Title and Duties
Dates of Employment:
Acknowledgement and Signatures
Consent
*
I understand that
I understand that my application is not a guarantee of admission but will be used to consider eligibility to live at the Arms of Love Home
Consent
*
I understand that
I understand that if my application moves forward that my references will be contacted to verify my character and the content of any portions of my disclosures in this application process
Consent
*
I understand that
I understand that Arms of Love Home determines application eligibility and reserve the right to not disclose the rationale for admission or denial
Consent
*
I authorize
I authorize Arms of Love Home to run a background check to verify any existing criminal record
Consent
*
I give
I give Arms of Love Home permission to request official documents and make professional inquiries to verify the information I have provided
E-Signature
My signature below signifies that all statements made are true and accurate to the best of my knowledge and that I have not withheld information.
Name
*
First
Last
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