OUR DAILY BREAD, MINISTRIES FELLOWSHIP HOUSES
APPLICATION FOR RESIDENCY
(Application needs to be made at least months prior to release)
Area in which you would like to live?____________________________
On a separate sheet of paper write your testimony. How did you come the Lord and why do
you wish to live in a Fellowship House? ________________________________________________
Print Name (last. first. middle / _____________________________________________________ Date of Birth / __________________
Current Address:
Street: __________________________
City ___________________________
State ______________ Zip ___________
Telephone you can be reached at: ________________
Are you now or have you been a user of drugs or alcohol in the past? If so date last used ______
Date of last Drink _________________ Date of last drug usage _____________________
Are you now employed? __________________ Where? _________________________
Address _________________________________ Phone ______________________-
What is your monthly take home income? ________________
Marital status ( )single ( ) married ( )separated ( )divorced
List two people that we can contact in case of accident or other emergency. Also on the back of this form list any special medical needs that you have.
The names of your doctors:
Name _____________________________________________
Address ___________________________________________
City _________________________________
State _________________ Zip __________________
I have read and agreed to all of the items above my signature on this application and understand that if I am accepted into the Fellowship House; I agree to the terms in that item including waiver of any landlord-tenant rights I might have with respect to residency in the Fellowship House. I understand that I fully subject myself to the rules of the house. Deposits will be refunded if an individual is required to leave. If leaving is voluntary and a two weeks notice is given at a weekly meeting, the security deposit will be repaid two weeks after the final utility bills are delivered by mail and appropriate deductions are made for my share of the costs.
The nature of the Fellowship House requires expulsion, without notice or refund of security deposit, of any member who is found by a majority vote of the house membership to be using either drugs or alcohol. Use of disruptive behavior or nonpayment of fees can lead to immediate eviction.
Signature___________________________________________ Date_____________________