Disqualifying Factors:

1) Persons who have records of sex offenses which presents a risk to the community.
2) Individuals with legal restraints which would preclude them from participating in the program and which cannot be sorted out by our Admissions office with the legal authority.
3) Individuals with medical problems which requires excessive time away from our residential program.
4) Individuals taking mind altering or mood changing drugs.

**If you do have children, please fill out the child information pages next for EACH child listed above.

**If you do not have children, please continue to the academic history section of the application.

Disclaimer: Home of Hope reserves the right to prohibit entrance to individuals taking mind and/or mood- altering medications (e.g., Lithium, Prozac, Haldol, Ritalin, Valium, etc.)

Please note: All medications used to treat depression, anxiety, pain and sleep disorders or other psychological problems are carefully screened at Home of Hope. Please consult your doctor before considering entry.

Also Note: All students accepted into Home of Hope must have a tuberculosis test administered. RESULTS of that test must be submitted on the day of entry.

The undersigned student applicant fully acknowledges that the information provided herein is accurate and true to the best of his or her knowledge, and the application form has been completed and filled out by the student applicant. The student applicant further understands that any false or incomplete information may cause and result in disqualification from admittance or continuation in the program. The undersigned student gives permission for Home of Hope to contact any of the forementioned people and/or institutions. The undersigned student also understands that his residency at Home of Hope is at the will of Home of Hope and may be terminated at any time and for any reason.