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
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Are you currently clean? If so what is your clean date?
*
Have you ever been a client in a Christian based recovery program before?
*
Yes
No
If Yes please provide where, otherwise put "None"
*
Is there pending or have you ever been convicted of a violent or sexual offense? If yes, please explain.
*
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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