The Mission of Yahweh

  • Mission of Yahweh Pre-Screening Form

    Trauma-informed pre-screening for adult women and mothers seeking shelter. Essential eligibility questions are required.

  • Applicant Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Permission to Leave Voicemail*
  • Have you ever been a resident at The Mission of Yahweh?*
  • Are you currently pregnant?*
  • Based on your response, you do not meet the eligibility requirements for the Mission of Yahweh residential program at this time. The Mission cannot accept you into the residential program. For pregnancy and maternal-health support in Harris County, contact Harris County Maternal & Child Health at 713-368-MOMS (6667). If you have a medical emergency, call 911.
  • Based on your response, you do not meet the eligibility requirements for the Mission of Yahweh residential program at this time. The Mission cannot accept you into the residential program. If you are in immediate danger, call 911. For confidential domestic-violence support, safety planning, and shelter resources, contact the Houston Area Women’s Center 24/7 hotline at 713-528-2121.
  • Have you experienced domestic violence within the past year?*
  • Have you been released from jail, prison, detention, or another correctional setting within the past 30 days?*
  • Are you willing and able to pass the Mission's required drug and alcohol screening?*
  • Current Living Situation*

  • Household and Child Information

  • Children/Dependents Information*
  • Current School or Daycare Attendance

  • Program Requirements and Willingness

  • Mission of Yahweh is a faith-based residential program. If accepted, you must remain on Mission property for the first 30 days to complete initial classes, orientation, assessments, and other program requirements, unless an exception is approved in advance by authorized Mission staff.
  • Are you willing to remain on Mission property for the first 30 days if accepted, unless an exception is approved in advance by authorized Mission staff?*
  • Are you willing to participate in faith and spiritual programming as part of the program?*
  • Are you willing to attend required classes, such as financial, parenting, vocational, leadership, and life-skills classes?*
  • Are you willing to meet weekly with a case manager?*
  • Are you willing to complete assigned service hours (up to 20 hours, depending on employment status)?*
  • Are you willing to follow program rules related to curfew, visitors, medication, sobriety, safety, and child supervision?*
  • Are you willing to complete required health, drug and alcohol, background, and documentation processes?*

  • Safety Screening

  • If you are in immediate danger or need emergency medical help, call 911 now.
  • Which of the following apply right now?*
  • Have you contacted emergency services or a crisis line about this situation?

  • Health Screening

  • Do you have health insurance?*
  • Do you have any medical conditions we should know about?
  • Are you currently taking any prescription medications?*
  • Are you currently taking any prescription medications?*
  • Do you have any allergies or dietary needs?
  • Based on your response, you do not meet the eligibility requirements for the Mission of Yahweh residential program at this time. The Mission cannot accept you into the residential program. For mental-health support, contact The Harris Center 24/7 Crisis and Access Line at 713-970-7000. If you are in crisis, call or text 988; for an immediate emergency, call 911.
  • Are you able to walk, stand, and use stairs independently without mobility assistance or ongoing staff support?*
  • Have you been hospitalized or received emergency medical care in the past 3 months?*
  • Have you been hospitalized for mental-health or psychiatric care within the past 3 months?*
  • Do you need any health-related accommodations or ongoing support?*
  • Are you currently receiving mental health care or counseling?*
  • In the past month, have you used any substances that could affect your participation in the program?
  • Do you need any health-related accommodations or ongoing support?*

  • Legal and Safety History

  • Do you currently have any active warrants?*
  • Have you ever had any of the following legal matters?*
  • Are you currently on probation or parole?*
  • Have you ever been convicted of any of the following?*
  • Are there any current protective orders, custody orders, or no-contact orders involving you?*
  • Do you currently keep any weapons where you live or stay?*
  • Have there been any safety concerns involving unsafe visitors, violent behavior, threats, or property damage?*
  • State disclosures do not automatically disqualify an applicant. Please provide complete and accurate information so the program can review your eligibility fairly.

  • Education, Employment, and Resources

  • Transportation available for work or program participation

  • Goals, Strengths, and Immediate Needs

  • Support system
  • First 30-day needs*

  • Acknowledgment and Final Eligibility

  • Based on the requirements explained above, do you believe you can meet the Mission of Yahweh program requirements?*
  • Should be Empty: