Women's Intake While in the program, you will be attending core classes that include Parenting, Co-Dependency, Addiction Cycle, 12 Steps, Boundaries, and Positive Cognitive Restructuring. You are also required to volunteer every afternoon at one of our four thrift stores that we operate. This is considered community service and a give-back opportunity since the program is completely free. You will receive weekly counseling sessions that focus on your unique needs. During those sessions, you will set personal and treatment goals that you work toward during your program and will plan on achieving upon graduation. The core plan of the program is intensive for the first nine months for each resident. We do not allow you to seek employment because of the daily activities you participate in to complete the program, which means you do not have an income. You will also be screened for drugs and alcohol three times a week. We view the first nine months as an opportunity to change your thinking, as well as behaviors that will allow you to return to society as productive members. Upon entry into the program all electronic devices (cell phones, tablets, laptops, etc.) are turned into offices as they cannot be used in the building. Finances will be handled by our financial specialist and secured in your own account to be requested through your case manager. After the year program, you will have the opportunity to join Aftercare. This is an optional two-year program that offers transitional living in a home with other graduates of the program. The Aftercare program requires random drug screening, as well as bi-monthly meetings to maintain accountability. f Women’s Intake Department womensintake@gracecentersofhope.org (248) 334-2187 x1902 Grace Centers of Hope 210 N. Perry Street Pontiac, MI 48342While in the program, you will be attending core classes that include Parenting, Co-Dependency, Addiction Cycle, 12 Steps, Boundaries, and Positive Cognitive Restructuring. You are also required to volunteer every afternoon at one of our four thrift stores that we operate. This is considered community service and a give-back opportunity since the program is completely free. You will receive weekly counseling sessions that focus on your unique needs. During those sessions, you will set personal and treatment goals that you work toward during your program and will plan on achieving upon graduation. The core plan of the program is intensive for the first nine months for each resident. We do not allow you to seek employment because of the daily activities you participate in to complete the program, which means you do not have an income. You will also be screened for drugs and alcohol three times a week. We view the first nine months as an opportunity to change your thinking, as well as behaviors that will allow you to return to society as productive members. Upon entry into the program all electronic devices (cell phones, tablets, laptops, etc.) are turned into offices as they cannot be used in the building. Finances will be handled by our financial specialist and secured in your own account to be requested through your case manager. After the year program, you will have the opportunity to join Aftercare. This is an optional two-year program that offers transitional living in a home with other graduates of the program. The Aftercare program requires random drug screening, as well as bi-monthly meetings to maintain accountability. f Women’s Intake Department womensintake@gracecentersofhope.org (248) 334-2187 x1902 Grace Centers of Hope 210 N. Perry Street Pontiac, MI 48342 I have read the program description and am ready to commit to the one-year life skills program Name(Required) First Last Today's Date(Required) Age & Date of Birth(Required)Date Phone(Required)Email(Required) Truthfulness Agreement(Required)Everything in this interview needs to be answered honestly. If you give any false information, you will be dismissed or disqualified from our program. Do you agree? Yes, I agree Have you ever been to Grace Centers of Hope? Yes No Do you know anyone in the men’s or women’s program at Grace Centers of Hope? Yes No Who and what relationship are they to you?(Required)What is the status of your driver's license or Michigan ID? Valid/Current Expired or not valid None Are you employed? Yes No Are you employed? If so, where?(Required)Do you receive disability or SSI? Yes No What are you receiving it for?(Required)Do you use drugs, alcohol, or inhalants? Yes No What is your drug of choice?(Required)When did you start using?(Required)Will you require a detox?(Required)Do you have any mental health diagnoses now or in the past? Yes No What are the diagnoses?(Required)How do the symptoms present in your daily life?(Required)Have you had any prior mental health treatment? Yes No For what and where were you treated?(Required)Are you currently seeing a psychiatrist? Yes No For what reasons are you seeing a psychiatrist?(Required)Are you on any medications for mental health? Yes No What are you taking and what are they prescribed for?(Required)List all medications you take. (We do not allow any narcotics, controlled substances, MAT therapy, or gabapentin)(Required)Can you be on a top bunk? Yes No Are you pregnant, or is there a possibility of being pregnant? Yes No Do you have any children? Yes No Details regarding children(Required)What are their names and DOBs? Would they be coming with you? • Do you have any CPS cases? • Do you have a visitation schedule (Note: Please bring their birth certificates and shot records.)Are you married? Yes No Are you willing to do a background check? Yes No Have you every been to jail? Yes No In what county were you in jail?(Required)Are you on probation or parole? Yes No Have you every been convicted of any crimes against children? Yes No Have you every been convicted of any violent crimes? Yes No Of what and when were you convicted?(Required)What are you seeking in this program?(Required)What would you like to work on?(Required)What do you think is important to know about you?(Required)What have been your major crises over the last 1–5 years, and how have you handled them? (Coping skills, mechanisms, or defenses.)(Required)Do you have any current or previous health problems? (Injuries, illnesses, allergies, eating patterns, sleep, etc.)(Required)When was the last time you had a physical?(Required)Please be aware that there is a lot of walking and stair climbing in our facility. Do you understand?(Required)Highest level of education completed? High school or less Some college College graduate Postgraduate degree Include any additional information you’d like us to know:Upload Files (If Applicable) Drop files here or Select files Max. file size: 256 MB.
