• Residential Program Intake Form

  • Have you spoken to Lantern Staff about the client you referring?*

  • The Lantern Project Residential Transitional Program Requirements:

    The Lantern Project Transitional Homes are intended to be a stepping stone to independence for survivors of sex trafficking and exploitation. It is our goal to provide an environment conducive to rehabilitation with guidance on personal growth and goal setting. We work to support and empower survivors as they begin their journey of healing and rebuilding. If you or someone you know is interested in applying for our program, please review the guidelines and requirements prior to completing the online application.

  • The Lantern Project Residential Transitional Program Requirements: 

    1. Age Requirement: Clients must be adults, in the state of NC that is 18 years of age. Client children are allowed in the program if they still currently live with client. Ages of children above age 18 may not be approved. 

    2. Survivor of Trafficking: Clients must be a survivor of trafficking, this could be labor trafficking, sex trafficking and/or exploitation, or other forms of trafficking. Clients must have experienced the trafficking incident within the last 8 years to qualify for the program. Unfortunately we cannot serve survivors or current victims of Domestic Violence. 

    3. Willingness to Participate: Clients must demonstrate a willingness to actively participate in the transitional program and engage in services aimed at their recovery and empowerment.

    4. No Immediate Safety Risks: Clients must not pose an immediate safety risk to themselves or others. This includes substance use, suicidal/homicidal ideations, 

    5. Commitment to Program Goals: Clients must be committed to achieving the goals outlined in the transitional program, which may include employment, education, job training, counseling, and rebuilding social connections.

    6. Respect for House Rules, other clients in home, and staff/volunteers: Clients must agree to abide by the rules and guidelines of the safe house, which may include curfew, visitor restrictions, substance use policies, and respectful behavior towards staff and other residents.

    7. Willingness to Participate in Case Management: Clients must be willing to engage in case management services, including assessments, goal setting, regular meetings with case managers, and participation in individualized service planning.

    8. Desire for Long-term Stability: Clients should express a desire for long-term stability and independence, including finding safe and stable housing, securing employment or education, and building a support network.

    9. Commitment to Healing and Recovery: Clients must be committed to their healing and recovery journey, which may involve participating in therapy, support groups, and other trauma-informed services.

    10. Agreement to Confidentiality: Clients must agree to maintain the confidentiality of other residents and the location of the safe house to ensure the safety and security of everyone in the program.

    11. No Active Warrants or Legal Holds: Clients must not have any active warrants or legal holds that would prevent them from participating in the program or accessing services.

    12. No Substance Use Impairment: Clients must not be under the influence of drugs or alcohol and have at least 3 months of sobriety upon admission. Clients must be willing to adhere to any substance abuse treatment requirements as part of their recovery plan.

    13. No Serious Medical Conditions: Clients must not have serious medical conditions that would require monitoring from staff or other individuals. This would also include monitoring from medical service animals. Unfortunately our housing program does not allow animals on property. 

    These requirements aim to ensure the safety, well-being, and success of all clients in the transitional safe house while providing them with the support and resources they need to rebuild their lives after experiencing sex trafficking. 


    Along with the requirements listed above, the following are highly requested and based on each individual before proceeding to being admitted to the transitional housing program:

    • Preferably has a CCA/pysch eval no older than a year from application date
    • Preferably has a current trauma focused therapist or at least trauma focused therapy scheduled
    • No suicide attempts within the last 6 months 
    • No Suicidal ideations with a plan within the last 3 months 
    • No self-harming behaviors within the last month
    • No psychiatric hospitalizations (ED hold or in-patient care) within the last 6 months
    • No serious medical conditions that would require monitoring(this includes medical service animals)
    • No current substance use of any kind
    • No service(emotional and/or medical) pets and/or animals allowed in the safe house
    • Preferably has their own transportation 

    Once you have read through the requirements and you or the person you would like to refer qualifies to apply for our program, please fill acknowledge you have read through our requirements and proceed to fill out the Residential Program Application  

  • Applicant's Information

  • Date of Birth:
     - -
  • Format: (000) 000-0000.
  • Have you recently experienced either of the following (within the last 8 years):
  • Safe to leave message?:
  • Do you have a Driver's License?:
  • Is your License suspended?:
  • Are you a U.S. Citizen?:
  • Are you eligible to work/go to school in the U.S.?:
  • Are you able to work/go to school at least 30 hours/week?:
  • Race:
  • What is your preferred language?
  • Do you attend church?:
  • Have you ever been a part of a residential program before?:
  • Who is seeking housing?

  • Relationship and Family Information

  • Current Relationship Status:

  • Background Information

  • Have you ever received trauma focused therapeutic services?:
  • Have you ever had a psychological evaluation or a Comprehensive Clinical Assessment (CCA) completed?:
  • Have you ever been diagnosed with a mental illness?:
  • Have you ever been hospitalized for a mental illness?:
  • Have you ever attempted suicide?:
  • Have you struggled with suicidal thoughts?:
  • Did you seek or receive treatment related to the suicidal attempt or thoughts?:
  • Do you or have you struggled with self-harm?:
  • Have you used drugs in the past?:
  • If yes, within the last 90 days?:
  • Have you had any alcohol in the past?:
  • If yes, within the last 90 days?:
  • Have you ever received treatment (inpatient or outpatient) for substance abuse?:
  • Have you ever been convicted of a crime (Felony/Misdemeanor)?:
  • Are there any outstanding warrants, tickets or pending criminal charges against you?:
  • Are you on probation?:

  • Background Information Continued

  • Have you ever been evicted?

  • Character References

    REFERENCES (Only use one personal resource (family member/friend) and one professional resource (therapist, physician, pastor, current program leader, probation officers, CPS workers, or case managers who you have current contact with.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Education

  • Do you have a H.S. Diploma or GED?
  • Are you currently enrolled in an education program?:
  • Have you ever received a loan for educational purposes?
  • Are you in default on any of these loans listed?
  • Do you have any outstanding debt (credit cards, loans, etc.)

  • Transportation

  • Do you have a car?

  • Work History

    (List employment beginning with most recent.)
  • Format: (000) 000-0000.

  • Children's Information

  • Immunization Records:
  • Gender:
  • Has this child ever received counseling?
  • Has he/she ever had a psychological evaluation?
  • Does he/she use drugs or alcohol?
  • Has he/she used drugs or alcohol before?
  • Does he/she use tobacco products?
  • Has he/she ever been physically or sexually abused?
  • Has he/she ever been convicted of a crime?
  • Is he/she on probation or in any legal trouble?:
  • Immunization Records:
  • Gender:
  • Has this child ever received counseling?
  • Has he/she ever had a psychological evaluation?
  • Does he/she use drugs or alcohol?
  • Has he/she used drugs or alcohol before?
  • Does he/she use tobacco products?
  • Has he/she ever been physically or sexually abused?
  • Has he/she ever been convicted of a crime?
  • Is he/she on probation or in any legal trouble?:
  • Immunization Records:
  • Gender:
  • Has this child ever received counseling?
  • Has he/she ever had a psychological evaluation?
  • Does he/she use drugs or alcohol?
  • Has he/she used drugs or alcohol before?
  • Does he/she use tobacco products?
  • Has he/she ever been physically or sexually abused?
  • Has he/she ever been convicted of a crime?
  • Is he/she on probation or in any legal trouble?:
  • Immunization Records:
  • Gender:
  • Has this child ever received counseling?
  • Has he/she ever had a psychological evaluation?
  • Does he/she use drugs or alcohol?
  • Has he/she used drugs or alcohol before?
  • Does he/she use tobacco products?
  • Has he/she ever been physically or sexually abused?
  • Has he/she ever been convicted of a crime?
  • Is he/she on probation or in any legal trouble?:

  • Parent/Child Status

  • Are you pregnant?:
  • Do you have any children not listed above?
  • Does CPS have custody of any of your children?
  • Are you or have you been involved with CPS?:

  • Agreement

    The information contained in the application is correct to the best of my knowledge. I understand that making false statements or being untruthful at any time will result in termination of The Lantern Residential Program.

  • Before proceeding with this application, Please have the client's referring individual/agenceny contact Lauren Penley, Residential Operations Supervisor, at lauren@thelantern.net or 828-228-1261 to set up a pre-application screening appointment. 

  • Should be Empty: