Thank you for your interest in the Pure Life Ministries Residential Program.
I realize that it may require a tremendous sacrifice for you to come to our program. However, I assure you that what God does for men here, if they have an open heart and a genuine desire to change, will last for the rest of their lives—and on into eternity!
Please take your time to carefully answer the following questions. This is a lengthy application and it will take some time to complete. Your progress can be saved at any time by scrolling down to the bottom of the page and clicking "Save and Return."
If you have any questions concerning the program or the application process, please contact our Director of Intake at intake@purelifeministries.org or by calling 859.824.2137.
In Christ,
![Luke Imperato](https://www.jotform.com/uploads/Jonathan_Willetts/form_files/Luke%20blue.6387c391d7cf26.19292638.png)
Luke Imperato
Director of Counseling