Central Care Mission Intake

Intake Application

Central Care Mission of Orlando, Inc.
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Central Care Mission is a men's residential life skills program that serves men who are:
- homeless
- in crisis
- struggling with substance use disorder
What you need to know:
- Curriculum focus is on five life skills: spiritual, physical, emotional, financial, and vocational.
- Requires a one-year commitment
- We find the most success in the men who stay longer than a year. It is likely that the potential client's situation was not created in 30, 60, or 90 days and therefore will not be improved in that amount of time, either.
- CCM is a structured working residential program, not a halfway house. Client movement is restricted; off-property passes are available after 90 days with case manager approval.
- CCM does not accept applicants with a sex crime conviction.
- Reading and writing in English is required. It is recommended that applicants have a minimum 6th grade reading level.
- Intake interviews are accepted Mondy through Thursday from 12 noon until 4:00 pm.

How much does it cost to enter the program?

Upon acceptance, client is not required to pay any money upfront, however, fees are billed to a client's account at intake.
- $175 Application Fee
- $190 Weekly Program Fee (assessed on Fridays, not pro-rated)
- $10 per day transportation fee as used
Client's pay will be deposited into a trust account and program fees will be paid from that account. Any earnings available after fees are assessed will be credited to client's savings. These savings will be returned to the client after a one-year commitment has been achieved and client has exited the program. If client leaves before commitment is completed, a $1000 fee will be assessed to his account. It is important to know that CCM is not government-funded. Private donations cover 52% of the cost for a client to enroll in the program.

Other important items to note:
- Clients are required to have hair above the collar and be clean-shaven.
- Physical fitness is a significant part of our program. Clients are required to work out at least three times per week.
- Clients are not permitted to have a cell phone for at least the first six months. After that time it will be determined by staff if one is needed.
- New clients may contact one friend or family member at entry to let them know they are safe and where they can be found. Then, clients will not have contact with friends/family for the first 30 days. This is the time to get settled and focus on recovery/transformation.
- Applicants should bring personal items (workboots, socks, underwear, toiletries, meds, etc.) to the interview for immediate enrollment.

Please indicate the party who is completing this application:*

Self (man applying to CCM)Case ManagerFriendFamily Member

Name of person (case manager, friend or family member) completing application:

First NameLast Name

Applicant's Full Name:*

First NameMiddle NameLast NameSuffix
One form of identification is required to be considered with an online application. If applicant does not have a form of identification then an in person interview is required before he can be considered. Does applicant hold identification? *
Upload a photo of the identification.*

Cancelof
Background checks are conducted for each applicant. Transparency is required.

CCM has the right to refuse entry of violent criminal convictions.

Does the applicant have any allergies that require an epi-pen?*

No / Not ApplicablePeanutsTree nutsShellfishEggsOther
Does applicant have any medical conditions that require ongoing medical treatment? For example, schizophrenia/bipolarity diabetes, cancer, cardiac or pulmonary issues? Full disclosure is required for a client to be accepted and to remain in the program.*

YesNoNot Sure
Explain the medical conditions that require or may require ongoing medical treatment:
Has the applicant been prescribed any medications that he is currently taking or should be taking according to healthcare professionals?*
What are the names of the medications he has been prescribed?
Central Care Mission is not a medical facility and therefore may be limited to the care we can provide to those with numerous medications (3 or more).

CCM requires that clients be willing and able to work. Many of the initial jobs that clients receive are labor-intensive or may require heavy lifting, standing and work outdoors. Does the applicant have any limitations?*

Please describe any physical limitations (bad knee, heat exhaustion, hernia):

Is the applicant currently receiving any of the following?*

Social Security / RetirementSocial Security / DisabilitySocial Security / SurvivorSupplemental Security Income (SSI)No / None

Is applicant a veteran?*

When did applicant last have a full-time job? Please include month and year.*
What was the job?*
How long did you have that job?*

Thank you for completing an online application for consideration at Central Care Mission. Please provide the best phone number for CCM to reach you regarding the application. If you are unable to be reached by phone, please contact CCM offices (407-299-6146) for more information.
Please enter a valid phone number.

Final Step - Background Check Authorization
Date of Birth*

MonthDayYear
Date
Gender*
Social Security Number*
Ethnicity*
Driver's License or I.D. #:*
Date License was Issued:

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
A copy of your submission will be emailed to the address provided.
Email
example@example.com
In connection with your program participation, residency, and/or employment with Central Care Mission of Orlando, Inc., notice is hereby given that a consumer report and/or investigative consumer report may be obtained from a consumer reporting agency for program participation or employment purposes. these reports may contain information about your character, general reputation, personal characteristics, and mode of living, whichever are applicable. They may involve personal interviews with sources such as your neighbors, friends, or associates. The reports may also contain information about you relating to your criminal history, credit history, driving and/or motor vehicle records, education or employment history, or other background checks.

You have the right, upon written request made within a reasonable time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report prepared by contacting Central Care Mission and Protect My Ministry (14499 N. Dale Mabry Hwy., Suite 201 South, Tampa, FL 33618; Phone: 1-800-321-6629). For information about Protect My Ministry's privacy practices, see www.protectmyministry.com. The scope of this notice and below authorization is not limited to the present and, if you are hired or granted residency, will continue to conduct future screenings for retention, promotion, or reassignment, as permitted by law and unless revoked by you in writing.

Applicant Signature*

Clear

Thank you for your interest in Central Care Mission.

Based on the responses provided in your application, we are unable to proceed with your application at this time. Here’s why:

Identification Required: Our program requires that all applicants have valid identification. It appears from your application that you may not have this available. Having valid identification is essential for accessing various services and support within our program.

Legal Status: We noted that you might have an outstanding warrant or an upcoming court date. Central Care Mission does not accept applicants who have pending legal issues as we focus on providing a stable environment for individuals who are ready to engage fully in their recovery without external legal distractions.

We encourage you to address these issues and consider reapplying in the future. If you have any questions or need further clarification, please do not hesitate to contact us.

Thank you for your interest in Central Care Mission.

If you are completing this application for a third party, please provide this information to the applicant.

Applications are reviewed within 48 business hours of submission.

If you are currently homeless, with no place to stay then please visit our offices during intake hours, Monday through Thursday from 12:00 pm until 4:00 pm; otherwise we encourage you to contact our offices to check the status of your application at 407-299-6146 or intake@centralcaremission.com as completion of an application does not guarantee intake.
Should be Empty:

Intake Application

Final Step - Background Check Authorization