Beauty for Ashes Women's Recovery Application

Thank you for your inquiry about Beauty For Ashes. Our goal is to help both men and women transition back into the world after completing treatment. We are a faith-based program that is a 501 c3 organization. We are not a medical nor a detox facility. If you need detox, you will need to be detoxed before entering the program. If you have health issues, please understand that we are not a medical facility and you will be referred to another facility.
In order to be accepted into Beauty For Ashes this application must be completed by the individual applying for the program. After receiving your application, we will review it and send a letter of acceptance or denial back to you. After receiving a letter of acceptance, you will have two weeks to write back or call to hold your bed. If you are incarcerated your bed will be held until you are released.
Isaiah 61:3 “To all whom mourn in Israel, he will give a crown of beauty for ashes, a joyous blessing instead of mourning, festive praise instead of despair. In their righteousness, they will be like great oaks that the Lord has planted for his own glory.”
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
Contact Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.

Fee’s:

There is a one-time intake fee of $300 when entering the program.
I   First Name   Last Name agree to the payment of $300 for intake for classes and counseling.
I   First Name   Last Name agree to the payment of $150 a week for rent upon getting a job.
I   First Name   Last Name agree that all information is true and complete on this form.
Signature

Clear
Date

MonthDayYear
Date
Clothing Allowance/Inventory:

Pants- 10

Shoes- 5

Makeup Bag- 1

Shirts- 10

Underwear- 10

Socks- 10

Bras- 3

Belts- 3

Jackets- 3

Backpack- 1

Purse- 1

Twin Sheets- 1 set

Blankets- 2

Pillows- 2

Towels- 3

Washrags- 3

Laundry Detergent- 1

Toiletries:

Shampoo

Conditioner

Toothpaste

Toothbrush

Shaving Cream, Etc.

ABSOLUTELY NOTHING WITH ALCOHOL (EX. MOUTHWASH OR HAND SANITIZER)

TOBACCO PRODUCTS ARE ALLOWED.

SNACKS AND DRINKS ARE ALLOWED.

DO NOT BRING NARCOTICS, VAPES, COMPUTERS, TABLETS, SECULAR BOOKS OR MUSIC, OR ENERGY SUPPLEMENTS.
Should be Empty:

Contact Information

Legal Information

Drug History:

Fee’s: