Are you interested in becoming a member of Anchor Ministries?
Please complete the following Anchor Pre-Admission Screening. Please answer all questions to the best of your ability.
Valid Email
*
example@example.com
Name
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First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Over the past 5 years in what cities & states have you resided?
Do you have any outstanding warrants or pending criminal cases? If so where? Please list all.
Is there pending or have you ever been convicted of a violent or sexual offense? If yes, please explain.
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Are you currently clean? If so what is your clean date?
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Are you currently or have you ever been a client in a Christian based recovery program before?
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Yes
No
If Yes please provide where and if currently in program please give anticipated graduation date. Otherwise put "None"
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What brought you to Anchor Ministries and why do you desire to be a part of Anchor Ministries?
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Submit
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