Nazareth Man House Application - Foresight For-Givers Foundation, Inc.

FORESIGHT FOR-GIVERS FOUNDATION, INC.
THE NAZARETH MAN HOUSE

Resident Application

Purpose: This application helps us determine readiness and eligibility for the Nazareth Man House. It is not a test, and there are no perfect answers. Please answer honestly and completely. All information is confidential and used only for program placement and safety.
SECTION 1: BASIC INFORMATION
Full Legal Name:*

PrefixFirst NameMiddle NameLast NameSuffix
Preferred Name: *
Date of Birth:*
Age: *
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Current Address (or where you are staying):*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name & Relationship:
Name:

PrefixFirst NameLast NameSuffix
Relationship:
Phone Number:
Please enter a valid phone number.
Do you have a valid ID?*

YesNo
(If no, are you willing to obtain one?)*

YesNo
Date of release (if within last 12 months):*
Are you currently on parole or probation?*

YesNo
If yes, Officer Name:

PrefixFirst NameLast NameSuffix
Phone Number:
Please enter a valid phone number.
SECTION 2: ELIGIBILITY & AVAILABILITY
Are you able to live in a structured, communal environment with other men?*

YesNo
Are you willing to follow house rules and daily schedule?*

YesNo
Are you willing to participate in all required activities (classes, work, meetings)?*

YesNo
Are you currently using drugs or alcohol?*

YesNo
If yes, are you willing to stop and submit to accountability?*

YesNo
Are you willing to work (employment, training, or assigned duties)?*

YesNo
SECTION 3: READINESS & MOTIVATION

Please answer briefly (1–3 sentences each).
1. Why are you applying to the Nazareth Man House at this time?*
2. What do you hope will change in your life during this program?*
3. What do you believe is the biggest challenge you face right now?*
4. Are you willing to be coached, corrected, and held accountable?*

YesNo
Please explain if needed:
SECTION 4: SAFETY & STABILITY SCREENING

(These questions help us keep the house safe for everyone.)
Do you take any prescribed medication?*

YesNo
If yes, list:
Do you have any diagnosed medical or mental health conditions that affect daily living?*

YesNo
If yes, explain briefly:
Have you ever been convicted of a violent offense?*

YesNo
Do you have any pending charges or active warrants?*

YesNo
Do you have a sex offense history? (Required for placement)*

YesNo
Are there any legal or personal restrictions we should know about?*
SECTION 5: FAITH ALIGNMENT

The Nazareth Man House is a Christ-centered recovery and discipleship program.
Are you willing to participate in spiritual activities (teaching, prayer, discussion)?*

YesNo
Are you open to being taught and challenged, even if you do not yet agree with everything?*

YesNo
Do you currently attend a church or have a pastor/mentor? (optional)*
SECTION 6: AGREEMENT & COMMITMENT

Please read carefully. If you agree, click the boxes below and enter your signature and date.
I understand the Nazareth Man House is a structured program, not a shelter.I understand this is not a job, but I will be expected to work and participate fully.I agree to follow house rules, schedules, and leadership direction.I understand that dishonesty may result in denial or dismissal from the program.I am applying voluntarily and desire change in my life.
I certify that the information provided is true and complete to the best of my knowledge.
Signature:

Clear
Date:
For NMH Use Only
Application received by

Clear
Decision:

AcceptedWaitlistDenied
Notes:
Should be Empty:

FORESIGHT FOR-GIVERS FOUNDATION, INC. THE NAZARETH MAN HOUSE

SECTION 1: BASIC INFORMATION

Emergency Contact Name & Relationship:

SECTION 2: ELIGIBILITY & AVAILABILITY

SECTION 3: READINESS & MOTIVATION

SECTION 4: SAFETY & STABILITY SCREENING

SECTION 5: FAITH ALIGNMENT

SECTION 6: AGREEMENT & COMMITMENT

For NMH Use Only

FORESIGHT FOR-GIVERS FOUNDATION, INC.
THE NAZARETH MAN HOUSE