Forge Application

John 5:6 “Do you want to get well?”

Basic Information

MM slash DD slash YYYY
Name(Required)
MM slash DD slash YYYY
Gender(Required)

Introduction

Do you struggle with continuous homelessness?(Required)

Drug / Alcohol Addiction

Would you say you currently have a drug or alcohol problem?(Required)
Have you been through any other programs?(Required)
Are you currently participating in any other programs (recovery/court ordered/etc.)?(Required)

Legal Information

Do you have any pending charges?(Required)
Have you been convicted of a felony?(Required)
Have you been convicted of a misdemeanor?(Required)
Are you currently on probation/parole?(Required)
Do you owe any court fines?(Required)
Do you have any legal obligations to the Friend of the Court?(Required)
Have you or do you currently have a CPS Case?(Required)

Health Information

Do you have any chronic or acute conditions that might impact your ability to work?(Required)
Do you have, or should you have, any restrictions for lifting, standing, walking or repetitive movement?(Required)
Do you have any planned, or have you been told you should have, any surgeries in the next year?(Required)
Are you currently taking any medications?(Required)
Are you struggling with any mental health issues and/or working with any mental health agencies?(Required)
Are you or have you been a client of Community Mental Health?(Required)
Are you currently working with any additional outside agencies(Required)

Employment and Training Information

Have you had difficulty holding steady employment?(Required)

Financial Information

Would you have any required payments to make while in the Forge program?(Required)

Transportation

I have a…(Required)

Parenting/Child Care

Do you have any children?(Required)
Do any of your children have behavioral or health issues that would impact them going to childcare or school on a regular basis or living in a busy environment?(Required)
Are your children receiving any mental health services or are they on medication for mental health concerns?(Required)
Are you required to pay child support?(Required)
Do you have any legal issues concerning your children (i.e., foster care, custody issues, child protective services involvement, etc.)?(Required)
Are your children enrolled in school or childcare?(Required)
Do any of your school age children participate in extracurricular activities or after-school programs?(Required)