• Application

  • Personal Information

  •  -

  • Education

  • Emergency Contact

    Other than your Legal Guardian, if applicable.

  •  -
  •  -
  • Secondary Emergency Contact


  •  -
  •  -
  • Family Information

  •  -
  •  -
  •  -
  •  -
  •  -
  •  -
  • Children

  •  - -
  •  - -
  •  - -
  •  - -
  • Employment History

    What were your last 3 jobs?
  •  - -
  •  - -
  •  - -
  •  - -
  •  - -
  •  - -
  • Financial Situation

  •  -
  • Other Sources of Income

  • Religious Beliefs

  •  -
  • Life Story

    Write a brief biography of your life, including your spiritual experiences. We want to get to know you better and we know it can be difficult to sum up your life. If you get stuck or don't know where to start, try thinking about your life a year at a time.
  • Medical Information

  •  -
  •  -


  • Chemical Dependency

  •  -
  • Substance Abuse

  •  
  • Legal Situation

    Current Status, Past Status, and Criminal Activity
  •  
  •  

  • Interest

  • Signature and Submission

  • Once you submit this application to Clear Waters Life Center, the program director and Mustard Seed Homes committee will review your application. We will contact you regarding your acceptance or non-acceptance into the Mustard Seed Homes Program.

     

    Please type your name below and click Submit to authorize Mustard Seed Homes to contact any individuals named in this application and to obtain a criminal background check.

  • Clear
  • Reload
  • Should be Empty: