Lantern Residential Program Application

Residential Program Intake Form
Have you spoken to Lantern Staff about the client you referring?*

YesNo

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

Relationship and Family Information
Current Relationship Status:

MarriedNever MarriedSeparatedDivorcedReconcilingWidowedOther
Maiden Name
First and Last Name of Current Partner:
Describe your relationship with your spouse/partner:
List previous marriages (Names and Dates):
Who do you feel is part of your support system?:
Describe your relationship with your parents:
Describe your relationship with your siblings and/or other family members:

Transportation
Do you have a car?

YesNo
Year/Make/Model:
Color:
Insurance Company:
Value: $
Running condition:
If you do not have a car, what are your plans for transportation?:

Work History

(List employment beginning with most recent.)
Business Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Supervisor:
Dates Employed:
Position(s) Held:
Hourly Wage:
Monthly Pay:
Reason for Leaving:
Other work history (please list name of business, dates, and reason for leaving) to give a full picture:

Parent/Child Status
Explain you/ your family's current circumstances and your needs:
What do you want to accomplish by moving to The Lantern Residential Program?:
Are you pregnant?:

YesNo
Do you have any children not listed above?

YesNo
Does CPS have custody of any of your children?

YesNo
If yes, please explain:
Are you or have you been involved with CPS?:

YesNo
Describe how your children get along with friends/teachers at school:
Describe your children's personality and behavior:
Describe your relationship with your children:
How do your children feel about the idea of coming into The Lantern Residential Program?:
Other comments about your children:
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.
Signature

Clear

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:

Residential Program Intake Form

The Lantern Project Residential Transitional Program Requirements:

Applicant's Information

Relationship and Family Information

Background Information

Background Information Continued

Character References

Education

Transportation

Work History

Children's Information

Parent/Child Status

Agreement