If you are human, leave this field blank.
Length of time at current address
Date of Birth
Total number of children
Are you currently pregnant?
Anticipated due date
Have you ever resided in a shelter, hotel, or transitional housing?
If so, where?
Who referred you? (friend, agency, online, etc.)
Employment (Most Recent First)
Education (Most Recent First)
Please list any prescription and non-prescription medicines, vitamins, home remedies, birth control pills, herbs:
Any other notes regarding your medication?
Do you have a current spiritual practice and/or attend church?
Transitional Housing Program
Lydia’s House of Hope is a 12 month Transitional Housing Program. Individuals accepted into our program are chosen based on their readiness and motivation to want to work on personal goals and dreams. You will meet with a Case Manager as needed weekly. They will work with you to set goals and monitor and assist you with the progress of your goals. The programming listed below are ones that you will participate in. The Case Manager will assist you with creating a manageable schedule and linking you to the resources you will need to reach your goals. Time Management Training Financial Literacy and Budgeting Transportation – Acquiring driver’s license and obtaining a vehicle In-House individual counseling W/ MLADC Cooking Classes: Healthy Eating and Grocery Shopping Parenting Classes Recovery Classes Job Skill Training Adult Education/Post Education/Higher Education Weekly Mandatory Essentials are: Morning Devotions – Monday – Friday 7am House Meetings – 1 time week Curfew is 4:30 pm to support a positive life style routine, and learn to work together in a family based atmosphere. Dinnertime meals will be shared Church on Sunday – Your choice
Finally, Lydia’s House of Hope is a Christian based Transitional Housing Program; therefore, we do not allow the teachings or meditations of other religions here. We reserve all rights to our religious position without complete rebuttle.
Is there any information that we have requested that you have questions on or would like to add any feedback?
Is there anything in this application that you do not understand?
FINANCIAL responsibility for living at Lydia’s House of Hope:
The program requires a monthly room fee of $300.00 due each month at the beginning of each month. A damage fee of an additional $300.00 is also required and will be held and returned upon departure after inspection and review of any incidents of damages while living at LHOH. While the first months room and damage fees, totaling $600.00, are required to move in, LHOH is aware that some individuals and families may have little or no income upon entry. If accepted into the program and you are experiencing a financial hardship you would be required to create a financial plan with our case manager to obtain financial assistance in order to secure your stay at Lydia’s House of Hope. NOTE: Security deposit is not returned if program is not completed. Completion is determined by successfully completing the 4 phases of the program and meet requirements of graduation per the staff and Case Management.
Do you have the ability to pay a monthly resident room fee and damage fee upon entry?
If No, please list why
Current Income and Sources
Current Expenses and Sources