• Housing Program Application

    Housing Program Application

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Marital Status:*
  • Do you have minor children?*
  • Are you currently homeless?*
  • Have you previously been a resident at The Oaks Ministry?*
  • Format: (000) 000-0000.

  • Health

  • Do you have health insurance?*
  • Are you currently pregnant?*
  • Are you under medical care at this time for any physical health conditions? (Mental Health is listed separately)*
  • If yes, list the condition and any medicine/s are you currently taking for your physical health?(Mental Health medications will be listed separate) List medicine, dosage, prescribing doctor and doctor's contact information:
  • Do you have any scheduled or pending surgeries?*
  • Can you safely use stairs, enter and exit the home, and leave the building independently during an emergency?*
  • Can you participate in required house meetings, case-management appointments, financial education, employment preparation, and a minimum 20-hour weekly work plan with your current condition?*

  • Mental Health

  • Have you ever been diagnosed with a Mental Health Condition?*
  • Are you currently under medical care for any mental health conditions?*
  • If yes, list the condition(s) you are being treated for and the name and contact information of the doctor(s) providing treatment:
  • During the past 12 months, have you been prescribed medication for a mental health condition?*
  • If yes, what medicines, if any, are you currently on? List medicine, dosage, prescribing doctor and doctor's contact information:
  • Are you currently taking all mental health medications as prescribed by your medical or psychiatric provider?
  • Do you currently have a physician, psychiatrist, therapist, case manager, recovery specialist, or other provider who will continue working with you if admitted into our Program?
  • Do you have a written crisis, safety, wellness, recovery, or discharge plan?
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  • Are you willing to sign a limited authorization allowing The Oaks to verify only the information needed to determine your ability to participate safely and the support you need?*

  • Employment

    The Oaks Ministry Policy may at times include a request to take a 90 day resting period before beginning work.
  • Are you currently employed? (We reserve the right to contact employer)*
  • Are you willing/able to work a minimum of 20 hours per week?

  • Financial

  • Do you have a checking/savings account?*

  • Recovery

  • Do you have a history of addiction to any substance, alcohol, sex, gambling, etc.?*
  • Names, dates, and length of stay at previous recovery programs:
  • Do you have a sponsor? (We reserve the right to contact your sponsor)
  • Format: (000) 000-0000.

  • Transportation

  • Do you have a current driver's license?*
  • Do you have a vehicle?*
  • Do you have auto insurance?
  • If accepted, would you have transportation to our Program?*

  • Education

  • Are you currently attending school?*

  • Legal

  • Have you ever been convicted of a sexual offence?*
  • Have you ever been arrested or convicted of a crime?*
  • Have you ever been incarcerated?
  • Are you on parole or probation? (We reserve the right to contact your Parole Officer)
  • Format: (000) 000-0000.
  • Do you have any pending legal charges?
  • List all current/pending charges below

  • Spiritual

  • The Oaks Ministry Program is a Christ-centered program. Are you open to learning about the principles taught in Christianity.*
  • I understand that The Oaks Ministry is not licensed by the Commonwealth of Pennsylvania as a drug and alcohol rehabilitation center or mental health facility. The Oaks Ministry staff do not provide clinical treatment, 24-hour supervision, nursing care, hands-on personal care, detoxification, or medication administration. I understand that I must fully and accurately disclose my current support needs so that The Oaks Ministry can determine whether the program can appropriately meet those needs. I certify that the information I provide during the application and admission process is true, accurate, and complete to the best of my knowledge. I understand that providing false or misleading information, misrepresenting my needs, or withholding relevant information may result in immediate denial of admission or dismissal from the program.*

  • Completed applications may also be submitted to:

    The Oaks Ministry Housing Program

    P.O. Box 29 Oxford PA 19363

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