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Contact info:
 
Email: MyFathersHouseHiram@gmail.com
Phone: 678-435-5951
 
 

To be in the program, applications are accepted and reviewed by My Father's House. Acceptance is granted based on meeting the program criteria. If you or anyone you know might need assistance please contact Marsha Bowen.

Part 1:
Application for Admittance

The information in this application is considered confidential.  This application is for screening purposes only and is not a commitment on either side that the applicant will become a client.  If the applicant does become a client, any information falsified will be reason for immediate dismissal from the program.

Are you at a facility?
Do you have children?
Do you have custody?
Do you have visitation rights?
Is DFACS involved?
Are you court ordered to pay child support?
Do you currently have legal problems?
Do you have an attorney?
Are you on parole/probation?
Do you have a high school diploma?
GED?
Have you ever been employed?
Do you have any physical or mental issues that would keep you from seeking employment?
Do you have any communicable diseases?
Have you been tested for:
Have you tested positive for any of these?
Do you receive any Federal Assistance?
Are you ready to commit to a one year Recovery Program?

Now complete the Application Questionnaire below.

Part 2:
Application Questionnaire

The information in this application is considered confidential.  This application is for screening purposes only and is not a commitment on either side that the applicant will become a client.  If the applicant does become a client, any information falsified will be reason for immediate dismissal from the program.

Do you smoke cigarettes?
Are you addicted?
Have you ever used a needle?
Do any of your family members struggle with addictions?
Were you ever sexually molested as a child?
Did you receive any counseling?
Have you ever been physically abused?
Have you ever hurt or cut yourself?
Have you ever had an eating disorder?
Have you ever attempted to take your own life?
Have you ever attempted to take someone else’s life?
Do you now or have you ever heard voices?
Have you ever been on mental health medications?
Have you ever been involved in the sex industry?
Have you ever been involved in the occult, witchcraft or satan worship?
Do you believe in God?
Do you believe the Bible is God’s Word?
Have you ever accepted Jesus Christ as your personal Savior?
At any time in your life have you been involved in church?

Thank you - we will get back with you shortly.

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