Residential Program Application

“Yet even now,” declares the Lord, “return to me with all your heart, with fasting, with weeping, and with mourning; and rend your hearts and not your garments.” Return to the Lord your God, for he is gracious and merciful, slow to anger, and abounding in steadfast love; and he relents over disaster. Joel 2:12-13

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

Director of Counseling

As part of your application we require a reference form to be completed by someone other than an immediate family member (preferably the pastor or an elder of your church).

Please enter the name and email address of the person you would like to be your reference. After you submit your application, they will be sent an email with a link to fill out the reference form. If your reference does not have an email address, please have them visit our application center at https://www.purelifeministries.org/application-center to fill out the online form.

Please make sure all questions have been answered before clicking continue.