Application - Bethel Outreach Ministries

Application

Bethel Outreach Ministries provides mental, emotional, and financial support services for men and women who have experienced incarceration. Please review the criteria to see if you qualify and fill out the application form below.

Criteria for Receiving Assistance

You must have been released from incarceration within the last 6 months.
You stay in incarceration being 2 months or more.
You have not received help from us in the last month: i.e. help with rent, utilities, deposits, Etc.
You must attend all meetings you have been ordered to (AA, NA, IOP, etc.)
You must be willing to accept any job you can get (Labor Ready, fast food, etc.) until something better comes along.
You must sign a contract stating you have received help from Bethel and will try to pay us back when get on your feet (no specific time). This allows us to help the next person released.
Providing false or misleading information will result in assistance being denied.
Incomplete and/or illegible application may be immediately denied.

Assistance Application

Incomplete, false, or misleading information, or illegible applications may be grounds for denial of assistance.

"*" indicates required fields

Step 1 of 3

Name*

Phone*

Date of Birth*

Where have you been released from?*

How long were you incarcerated? Release Date?*

Have You Ever Received Assistance from Bethel Outreach Ministries?

Yes

When was the last time Bethel Outreach Ministries helped you?*

What did Bethel Outreach Ministries help you with?*

What AA, NA, or other recovery meetings do you attend? How often?*

What is your living situation?*

Who is your next of kin?*

Next of kin relationship?*

Anything that you think we need to know to help us deterimine the eligiblity or level of assistance.

Authorization*

I agree

I hereby authorize Bethel Outreach Ministries to share information with other organizations. To meet the needs of our clients we must be able to share information with our partners in order for our services to be efficient. Therefore ALL clients must sign the following release of information statement authorizing Bethel Outreach Ministries to share and receive their personal information.

I hereby authorize Bethel Outreach Ministries to release information about me to whomever and whenever Bethel Outreach Ministries deems necessary and appropriate. I further authorize all parties refereed to in the application to share personal information with Bethel Outreach Ministries to verify the accuracy and authenticity of all information provided by applicant.

Phone

This field is for validation purposes and should be left unchanged.