Program Consent Forms

  • MEN'S STUDENT APPLICATION

  • All information will be confidential and for use only by those who oversee the program. All applicants must be willing to agree to complete the program, regardless of time required.

  • CRIMINAL CHARGES STATEMENT

  • I , am acknowledging through this statement, and as listed on The Potter’s House application, that I have no criminal charges that are related to the following offenses:


    • Egregious Acts of Violence 
    • Arson
    • Rape or any Sexually Related charges in general. 


    I am also attesting to the fact that I am not listed on Megan’s List.


    ---------[INMATE must have this section below completed by official]: -------------

  • Please review the program information and, if interested in admission, complete the following application, sign this form, and submit the application and form to the Potter’s House for review.

    I,         , have read The Potter’s House Phase One Guidelines and agree to abide by them as long as I am in “the hands of the Potter.” I understand that this is both a discipleship and a recovery-oriented program. By signing this agreement, I commit myself to adhere to the rules, financial responsibilities, counseling, and other activities as determined by staff. I am asking for help to turn from my old lifestyle, and becoming a “new creation” in Jesus Christ as I transition back into the community.

  • Clear

  • We the Potter’s House staff commit to doing our part in providing a helpful, Christ-centered, life changing program. We will strive to create and maintain a healthy environment in which each person is respected and inspired to personal growth.

    While you wait for approval:
    1. Pray for Gods guidance to be sure that the Potter’s House is His will for your immediate future.
    2. Ask your family, church, and other individuals for guidance in this area.

  • PROGRAM FEES OVERVIEW

  • Phase One (3 months): $1800 per month

    Phase Two (6 months): Based on employment income 

     
    NOTE: The Potter’s House does not deny admission based on lack of program fees. 

     
    • Within the first 30 days of entrance to Phase One, you will meet with our Finance team to evaluate your personal financial status, needs, and goals—as how this relates to paying toward your program fees. 

     
    • Upon entrance to Phase Two you will be assisted in obtaining full-time employment with a local employer. (Average income is usually between $15-$18/per hour)

     
    • After 2 weeks in Phase Two, you and our Finance team will establish a working budget that is crafted specifically to your individual needs. This will assist you in submitting a portion of your income to your program fees—and toward any debt, child support, fines, etc. you may have incurred prior to entrance –as well as developing a saving account.

     
    • Keep in mind the more you are able to pay towards your program fees upon entrance will help to lessen the payment amount toward your program fees. 


    • Do not let finances/fees deter your decision to enter. All plans created with the Finance team are fair, easily manageable, and designed for your financial stability beyond The Potter’s House.

  • Should be Empty: