• Still Waters Housing Application

    Please complete the full application in one sitting - the form will not save if you walk away from it.
  • Did you read the Still Waters informational sheet?*

  • Before completing this application, we require that you read the informational sheet found at here. You will not be able to submit application without watching.

  • Have you lived in any Open Door Ministries or Providence Network homes before?*
  • Which house have you lived in?*
  • Please indicate which housing program are you looking for.*
  • Format: (000) 000-0000.
  • Is it safe to leave a voicemail?*
  • Is it safe to email you regarding your housing application?*
  •  - -
  • Sex*
  • Gender*

  • Within our residential properties, we have a variety of types of homes. Most of them, however, are specifically for men or women.  In our homes that are designated for men or women, residents are admitted based on their biological sex. Thus, we admit residents who identify their gender according to their biological sex. This policy would not relate to our facilities that accept both male and female residents. Our hope is to be able to provide resources and referrals for all those in need including trans* and non binary individuals. 

    In conclusion, we understand that these issues are complicated and difficult. As stated above, we are committed to loving each person where they are and offering biblical guidance ministering both truth and love to each person as God’s creation. As always, we invite questions or concerns regarding our policies and hope to find truth and grace solutions together.”

  • Marital Status: (check all that apply)*

  • Please be advised that Still Waters Housing serves single women. 

  • Ethnicity:*

  • Children

  • Do you have children currently in your custody?*

  • Treasure House is only able to consider applicants who have children 3 years and younger at the time of intake. 

  • Are you currently pregnant?*
  • Do you have children who do not live with you?
  • Do you have an open or ongoing custody case?

  • Current Circumstances

  • Education

  • Highest level of school completed:*
  • Do you have any diagnosed learning disabilities?*
  • Are you currently enrolled in classes?*

  • Employment

  • Are you able to work 15-40 hours/week?*
  • Are you currently employed?*
  • Are you willing to keep your working hours between 5am and 5pm in order to meet program requirements?

  • Other Sources of Income

  • Do your receive monthly assistance from TANF?*
  • Do your receive monthly assistance from SSI/SSDI?*
  • Do you receive unemployment income?*

  • Legal History

  • Have you ever been convicted of a crime?*

  • While we do accept people with criminal histories, including felonies, City Ordinance 565.28.1, prohibits us from accepting those who are currently serving probation or parole for a crime against a person and those who have an outstanding warrant.

  • Are you currently on parole or probation?*
  • Do you have any outstanding warrants?*

  • Drug & Alcohol History

  • Do you believe you have an addiction?*
  •  - -
  • Do you believe you have other addictions (eating, unhealthy relationships, spending, etc.)?*
  • Are you open to participating in a recovery group, meeting or program?*

  • Sex Industry History

  • Have you ever exchanged sex for money, food, drugs, housing, etc.?*
  • Have you ever been sexually exploited? - Sexual exploitations is defined as an actual or attempted abuse of someone's position of vulnerability (such as a person depending on another for survival, food rations, transport or other services), differential power or trust, to obtain sexual favors, including but not only, by offering money or other social, economic or political advantages. It includes trafficking and prostitution.*

  • Physical Health History

  • Do you have any disabilities or medical conditions that keep you from working or limit the type of work you do?*
  • Are you able to use stairs?*

  • Mental Health History

  • Have you had previous counseling or mental health care?*
  • Are you currently seeing a psychologist/psychiatrist/counselor?*
  • Have you ever been hospitalized for psychiatric reasons?*
  • Are you currently taking Suboxone?*
  • Are you currently taking Methadone?*

  • Family History

  • Have you ever lived in a group home or foster care?*
  • Previous generations of my family have been involved with: (check all that apply)*

  • Religious Beliefs

  • Are you open to exploring Christian spirituality as part of this program?*

  • Experience Checklist

  • Rows
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  • References

    3 References Required

  • Please list both personal and professional references below. Suggested refernces: probation or parole officers, case managers, mental health providers, counselors, psychiatrists, friends, family, or employers.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Background Check

  • Should be Empty: