Men's New Life Program application


Dear New Life Program (NLP) Applicant,

Thank you for your interest in the New Life Program at The Rescue Mission. Please fill out the application carefully and completely. 

Your application will be sent to the New Life Program staff committee for review. When there are openings in the program, you will be contacted for an interview.

You will need to call 253-383-4493 every Thursday between 8-10am to keep your name and application on the wait list.
The Tacoma Rescue Mission:
exists to offer God’s Help, Hope and Healing by sharing our Christian faith and striving to provide a permanent pathway out of poverty for people experiencing homelessness in Tacoma and Pierce County.

The New Life Program is:
✓ Christ-centered, because we know that the best hope we can offer to anyone is life transformation through a relationship with Jesus Christ. The New Life Program is open to men of any faith background; participation in Bible studies, Christian discipleship, and Christian church worship services is a required part of the program.

✓ an 8-12 month Christian discipleship and addiction recovery program, providing clean-and-sober housing and meals. The program is full-time and the schedule does not allow for employment until the last phases.

✓ not a state-certified program, so no formal chemical dependency assessments are conducted.
✓ an abstinence-based recovery program. Habit-forming medication is not allowed (narcotic pain medication, methadone, suboxone, marijuana, alcohol and others).

✓ a program with wrap-around services including basic adult education/other individualized education support, career navigation, case management, individual and group counseling, work therapy, service projects, recreational outings and support groups, access to community recovery programs including; Celebrate Recovery(CR), Alcoholics Anonymous(AA), and Narcotics Anonymous(NA), and opportunity to attend and engage in local church community. All program components are mandatory.
Program Eligibility:
✓ 18 years of age or older

✓ Desire for addiction recovery support; willingness to abstain from the use of all mindaltering substances, including alcohol and marijuana

✓ Prepared to enter the program immediately upon acceptance

✓ Homeless and low-income

✓ Able to provide full and honest disclosure of history, current situation on application and in interview

✓ Able to independently provide care for self and living unit (ADLs-basic and instrumental)

✓ Able to share residential space and live in a community setting ✓ No active arrest warrants, no history of sexual offenses
Intake Requirements:
✓ 24-48 hours since last use of drugs/alcohol. Must submit a urine sample for testing at intake interview. If medical detoxification is needed, this must be completed (must provide discharge paperwork) before the intake interview.

✓ Provide picture ID

✓ Provide social security card, or proof of application for replacement card

✓ Signed consent for criminal background check

✓ Complete application for Supplemental Nutrition Assistance Program

✓ Medical and mental health appointments complete; any prescription medication refilled

✓ Release of information signed (for probation officer, other service providers)

Focus Period:
Once accepted into the New Life Program, participants are restricted to TRM/Men’s Campus property for the first 30 days as a Focus Period. The purpose of the Focus Period is to provide rest, safety, and time to get settled and acclimated to the program.

Important appointments should be arranged prior to entry into the program medical, mental health services, etc.
No phone calls, outside appointments, or visitors allowed during the Focus Period, without approval by the Program Manager.

I have read and understand the instructions.
Signature: *
Income: *
EBT-Food Stamps
Work History. List your three most recent jobs by date, employer and why you left. *
 Dates From - ToEmployerWhy you left
List all substance use:
 Drug/AlcoholAge StartedDo you think you are addicted to it?Date Last Used?
List all recovery programs in which you have been enrolled:
 DatesFacility/Program & LocationInpatient or Outpatient?Treatment completed?
List all prior criminal convictions:
 ConvictionDateTime ServedState/County of conviction
When were you last tested for the following: *
Hepatitis B
Hepatitis C
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
New Life Program Agreement
I need the New Life Program (NLP) because I have serious life-controlling addictions and issues.

Acknowledge: I acknowledge that I am powerless over my addiction – that my life has become unmanageable. I want change in my life and acknowledge that I need help from others in taking the next steps towards recovery.

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

Relationships: I will live without relationships that conflict with my recovery.

Accountability: I will choose to be accountable to others for my actions.

Responsibility: I will take responsibility for my attitudes, actions, behaviors and choices and will learn about the impact my choices have on people around me.

Residential Units: I understand that the Rescue Mission (RM) provides residential units for participants of the Men’s New Life Program at the Men’s Campus. These units are shared with other program participants and are drug/alcohol free. Exiting from the program will result in my exiting the residential unit, and I must remove my belongings at the time of exit.

Compliance: I agree to comply with the Program Guidelines. I agree to set goals with staff/interns working with me and make continuous progress towards reaching those goals. Failure to progress in any part of my program may be a choice to exit the program. *
Signature authorizing release of information: *
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