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JOE'S INFO

email: Joe@elijahhouseliving.com


Office Number: (530) 854-4119                            Mailing Address: P.O Box 2456 Oroville CA, 95965


Direct Number: (530) 868-7091



 

Application

Please fill out the following application if you are interested or required to be a resident of The Elijah House. There are 49 questions please answer to the best of your ability. This application is for all programs that we currently offer. 

 

Please complete the form below

1. Name *
1. Name
2. Date *
2. Date
4. Birthdate *
4. Birthdate
7. Attorney Phone
7. Attorney Phone
8. Your phone
8. Your phone
9. Are you on Probation or Parole? *
11. Court Date (if any)
11. Court Date (if any)
Location of Court Hearing
Sentencing or Preliminary
Be DETAILED (only if you have cases pending)
15. Are you a drug addict? *
16. Are you eligible for or in Drug Court? *
17. Are you on SDI, SSI, Unemployment, Indian Money, or Pension? *
18. Do you have to register as a 290, or had sex with a minor? *
19. Are you an arson or have you ever been arrested for Arson? *
21. Are you a Christian? *
24. Did/Do you smoke cigarettes? *
25. Did/Do you drink alcoholic beverages? *
28. Are you able to pay dues each month on time? *
29. Can you lift 50-75 pounds? *
33. Have you ever had a Psychological or Psychiatric diagnosis? *
36. Do you suffer from back pain? *
37. Can you read and write the English Language? *
38. Do you have a GED or High School Diploma? *
39. Do you have a valid picture I.D Card (must have)? *
40. Do you have a Social Security Card (must have a card or receipt)? *
42. Have you ever completed a residential program successfully? *
44. Are you willing to follow all Elijah House rules and policies, including any obligation given from any authority? *
45. Do you qualify for any type of AB 109 funding? *
46. If sentenced; Do you qualify for ACS? *
48. Are you willing to commit to 6 months? *
Designated Family Name:
51. Designated family phone *
51. Designated family phone
52. Address *
52. Address