Women's New Life Program application

NOTICE: THESE INSTRUCTIONS ARE IMPORTANT & INCLUDE IMPORTANT ELIGIBILITY REQUIREMENTS. PLEASE READ CAREFULLY BEFORE APPLYING
 
Thank you for your interest in the Women's New Life Program (WNLP) at The Rescue Mission. Please fill out the application carefully and completely. 

Incomplete applications will result in a delay for intake interviews. Returning this application does not guarantee acceptance into the program.  An interview does not guarantee entrance into the WNLP.

Once this application is received by the Program Manager, she will review it and contact the applicant for a phone prescreen.  If the applicant does not have a phone number or email, she will need to contact the Program Manager at 253-383-4493 x 1548  If the Program Manager is unable to contact the applicant via phone or email or does not receive a response from the applicant, the application can not be processed further until contact is made and will be considered inactive (not eligible for the next available opening). The Program Manager will make two attempts to contact applicant and then it is the responsibility of applicant to make contact. 
 
There is no financial cost or fees to participate in the program.
 
Once an opening in the program becomes available, the Program Manager will contact the first person on the Wait-List and schedule an interview.  If she is unable to reach that person or there is no response within two (2) business days, the next applicant will be contacted.
Eligibility Requirements:

While there is no cost to participate in the program, there are income limitations. If you have income, you must present verification of income and it must be at or below the limitations as listed in the table below (in accordance with family size):

Family Size          Annual Income      Monthly Income
One Person           $18,200               $1,517
Two People           $20,800               $1,733
Three People        $23,400               $1,950
Four People          $25,950                $2,163
Five People           $28,050               $2,338
 
✓ You must be at least 18 years old to apply for the program.
 
✓ If you require detoxification, the NLP does not conduct detox nor arrange for it. Detox must be arranged and accomplished prior to intake by the applicant.
 
✓ Applicants who are inebriated will not be interviewed. You may be UA’d or given a breathalyzer test.
 
✓ You cannot be involved in a romantic relationship. Participants in this program must be willing and able to devote their full attention to their own growth and healing while in the program. They must be willing to terminate or suspend any active romantic relationships at the time of admittance to the program and agree to not initiate any romantic relationships while in the program.
 
✓ A thirty-day FOCUS PERIOD begins upon entry into the program.
     o Inform Program Manager of any prior scheduled appointments.
     o Program Manager approval required for any phone calls, outside appointments, or visitors.
     o Have enough prescription medication to last Focus Period.
 
✓ The New Life Program (NLP) is an 8-12 month residential recovery program. No outside employment or schooling while participating in the NLP. Employment/education may be authorized during the last phase or as approved by Program Manager.
 
✓ Our program is Christian based. Although non-Christians are welcome, all clients are expected to attend a Christian Church, Bible studies, and other Christian activities.
 
✓ ALL pending legal issues (court dates, etc.), with the exception of CPS-related matters, should be resolved prior to consideration for acceptance into the program. Outstanding warrants may prohibit acceptance – these legal issues need to be resolved or discussed with Program Manager prior to admittance.
 
✓ CPS-involved applicants are accepted on a case-by-case basis. If CPS/court requirements prohibit full participation in the program, we cannot accept applicant.
 
✓ The program requires a considerable amount of reading and writing. If you are unable to read and comprehend adequately, this program may not fit your needs.
 
✓ Medical and psychological diagnosis may or may not be an issue for admittance. Each is handled on an individual basis. Some diagnoses are beyond the scope of the NLP to accommodate.
 
✓ All medications must be disclosed and turned into staff upon admission.
 
✓ Any applicant taking prescription narcotics, Methadone, or Suboxone will not be accepted.
 
✓ All applicants must be willing to submit to a UA/breathalyzer on the day of intake.
 
✓ You must agree to a Washington State Patrol criminal background investigation. A criminal history will not suspend you from application or acceptance to the program. Level 2 and 3 sex offenders are NOT eligible for our program.
 
✓ There must be full and honest disclosure on this application.
 
✓ Children living with you must be in school or daycare. We do not provide daycare and you must be able to participate in all elements of the program.
 
✓ New Life Program Participants purchase and prepare their own food in fully furnished kitchens, so food stamps or adequate income required to meet food needs.
 
✓ Required ID, Social Security Card, and Medical Insurance information.  Please notify Program Manager if you do not have these items.
I have read and understand the instructions. Sign below: *
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NOTE: If it is discovered that you have not been truthful in your responses on this application and during the oral interview, you may be removed from the program. Honesty is important and valued by the WNLP.
Work History. List your three most recent jobs by date, employer and why you left. *
 Dates From - ToEmployerWhy you left
1
2
3
List all substance use:
 Drug/AlcoholAge StartedDo you think you are addicted to it?Date Last Used?
1
2
3
4
5
6
7
Other compulsive problems *
Scale 1 Header
yesno
Nicotine/Cigarettes
Gambling
Sexual
Pornography
Relationships
Food/Eating
Computer/Internet
Television
Shopping/Spending Mondy
Body Image
Lying
Procrastination
List all recovery programs in which you have been enrolled:
 DatesFacility/Program & LocationInpatient or Outpatient?Treatment completed?
1
2
3
4
List all prior criminal convictions:
 ConvictionDateTime ServedState/County of conviction
1
2
3
4
5
6
Do you suffer from any of the following? *
Scale 1 Header
YesNo
Trouble Sleeping
Frequent Headaches
Eye or Vision Problems
ANY Allergies (food, drug, medication)
Blood in Stool
Tremors
Seizures
Difficulty Breathing
Sores that do not Heal
HIV/AIDS
Suicide Attempts
High Blood Pressure
Diarrhea/Constipation
Sexual Issues
Stomach/GI Problems
Liver Problems (Hepatitis?)
Diabetes
Persistent Respiratory (cough, etc)
Any Contagious Condition(s)
Venereal Disease/STD
Other
Do you have any chronic medical issues (including vision or hearing loss or dental emergencies)?
 Diagnosis/ConditionDate StartedUnder the care of a Physician? Y/N
1
2
3
4
5
Spiritual Background

NOTE: Being a Christian is not a prerequisite for admittance to the program, but pay attention to the questions and notes below.
NOTE: If you are practicing another faith:

• For the required course work, only an approved Christian Bible may be used.
• You will not be allowed to perform rituals (bowing, chanting, incantations, sacrifices, etc.) associated with your faith within the confines of the WNLP.
• You are not allowed to argue or debate faith against faith.
• You are not allowed to teach tenets of your non-Christian faith.
• Reason: all of these things may pose a stumbling block to young believers within the program.
• Staff welcomes any questions regarding faith and belief. Please seek out a staff member for these questions.

Women's New Life Program Agreement
I need the Women's New Life Program (WNLP) because I have serious life-controlling addictions and problems.

During my recovery at the WNLP I agree to the following:

Acknowledge:  I acknowledge that I am powerless over the effects of the choices I have made thus far in my life – that my life has become unmanageable. I acknowledge that it is necessary for me to submit to authority and that compliance with the guidelines and teachings within the Women's New Life Program (WNLP) can be a beginning to a new, fulfilling, and healthy life.

Alcohol/Drugs:I will live alcohol and drug free.

Relationships: I will terminate or suspend any active romantic relationship prior to entering the New Life Program and I agree not to initiate any romantic relationships while in the Program.

Accountability: I will remain accountable for my actions.

Responsibility: I will take responsibility for my attitudes, actions, behavior, and decisions.

Facilities: I understand that the Tacoma Rescue Mission (TRM) invites applicants into their Women's New Life Program at the discretion of the WNLP staff, and those clients are housed at the TRM facility. The WNLP has authority over the portion of the facilities designated to house WNLP clients. Removal from the program will result in my vacating the WNLP portion of the premises.

Compliance: I agree to comply with the Program Guidelines and the direction of the Women's New Life Program and Tacoma Rescue Mission staff.

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Signature authorizing release of information: *
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