Application Form (Answer All Questions)

The House Where Jesus Shines will only accept applications from men on parole, probation, out of county jail, or state jail. Family or friends request will be discaded. Each man must demostrate a desire to come to the house and to comply with the program's requirements to be considered.

Any untruth given will automatically disqualify you for this program. If accepted, any alcohol or illegal drug use will result in automatic dismissal.

Do you owe child support?



Do you owe household or spousal support?



Are you being released on parole or probation?



Is electronic monitoring a requirement of your parole?



Are you a registered sex offender?



Are you HIV positive?



I am voluntarily applying to the House Where Jesus Shines. I do hereby indemnify and hold harmless the House Where Jesus Shines, including its officers, directors, or agents on behalf of the House Where Jesus Shines, from any and all claims, demands, actions, and suits, resulting from any physical injury, property damages, or other personal loss which I may incur as a result of my residency at the House Where Jesus Shines.

I understand that if I become more than one week delinquent in paying the program fee, the House Where Jesus Shines has the right to terminate and remove me from the program and remove me from the premises. I give permission for the House Where Jesus Shines to request a criminal history record from all law enforcement agencies.

I give permission for the House Where Jesus Shines to request a criminal history record from all law enforcement agencies.

I promise that I will cooperate with the rules, regulations, guidelines and policies of the House Where Jesus Shines and will participate in the activities of the House Where Jesus Shines, which have been provided for my benefit.

I have read all the above questions, statements and agreements and fully understand them and willingly submit this Application for Residency knowing what I am doing.