Download a printable copy of the full PDF application form.
Residents who have not received their high school diploma or GED are encouraged to enroll, with House Parent assistance, in the G.E.D. program at the local community college or attend middle or high school.
Do you feel like the following people listen to what you have to say?
Previous Employment (Please list previous employers & length of employment at each)
If you are insured or covered under an individual or family policy, please complete the following:
If you do not have insurance, you may be eligible for Title IXX (Medicaid) or other state government coverage. Please bring the following when you arrive for check in at Ruth Harbor. We have a copier so you can bring the original documents if you want. -Social Security Card -Copy of Birth Certificate
By submitting below, I verify that all information is correct and accurate on this application.
Homes where God’s love transforms lives.