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Home
Our Services
Do You Need a New Beginning?
Baby Boutique Programs
Community Resources
>
Medical
Education
Parenting
Financial
Housing
Legal & Mental Health
Food Pantry
Testimonials
Donate Now
One-Time Donation
Recurring Donation
Gift Catalog
Material Donations
>
Target Registry
Amazon Wish List
Walmart Registry
Wish List
Merch
Getting Involved
Career Opportunities
Volunteer
>
Volunteer Time Log
Internships
>
Resident Supervisor
Media Design Internship
Film Production Internship
Resident Support Internship
Marketing Internship
Social Media Internship
Customized Internship
Events
>
Ministry Presentations
Wine & Dine
Change for Life Program
About Us
Virtual Tour
Our Team
Board of Directors
History
Newsletter
Contact Us
Heart Campaign
Eligibility Screening
This screening is to be filled out by the potential resident and no one else. If it is found otherwise, you will be automatically disqualified.
*
Indicates required field
Today's Date: Month/Day/Year
*
Tell us about yourself
Name
*
First
Last
Age
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18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Phone Number
*
Email
*
We can only help mothers who are pregnant or have one child in their care under 12 months.
Please Pick One
*
Currently pregnant
Child under 12 months
Due date or child’s birthdate: Month/Day/Year
*
Where are you currently staying:
*
Friends
Family
Shelter
Streets
Own place
Out of car
Other
City and State of current location:
*
Does your baby’s father plan on being involved in your child’s life:
*
Please choose one
Yes
No
Maybe
List any family that you are currently on speaking terms with:
*
New Beginnings is a Home for Single Mothers and cannot accommodate those who are married.
Are you currently married:
*
Please choose one
Yes
No
Have you ever been married:
*
Please choose one
Yes
No
All New Beginnings residents must further their education through traditional schooling or a trade.
What is the highest level of education completed:
*
Please choose one
Grade 9
Grade 10
Grade 11
Grade 12
Some college
Associate's degree
Other
Any current income:
*
Job
W2
WIC
FoodShare
State Insurance
Other
New Beginnings is a faith-based organization, and a lot of the programming revolves around our Christian faith. Residents are not required to be Christian but must be willing to learn and study the Bible with an open mind.
What is your religious status or your beliefs:
*
All residents will have their own bedroom with lock and key but will share a two-bedroom apartment with another mother on the second floor. Living close to others requires a physical before entering the program.
What is your physical health status (Do you have communicable diseases, inability to climb stairs, asthma, diabetes, high blood pressure, or any other physical diagnosis?)
*
Mental health is just as important as your physical health and therefore, New Beginnings cares for your overall wellbeing.
What is your mental health status (Have you been diagnosed with depression, anxiety, bi-bolar, etc. Do you feel you may have any of the before mentioned?)
*
Have you experienced anything in your life that you would consider traumatic? (Traumatic: Emotionally disturbing or distressing)
*
Have you experienced anything in your life that you would classify as abuse? (Abuse: Having been treated with cruelty or violence, especially on a regular basis)
*
New Beginnings’ program is a life change and a new beginning. This takes hard work, patience, and understanding. New Beginnings’ program requires all residents to attend regular counseling to help with this transition.
Are you interested in attending counseling?
*
Please choose one
Yes
No
Maybe
Have you attended counseling before?
*
Please choose one
Yes
No
Are you currently taking, or have you been prescribed medication that you should be taking and what is it prescribed for?
*
New Beginnings performs a background check on all applicants. You can say yes to the following question and still be considered for the program.
Do you have a police record and, if so, what was it for?
*
New Beginnings performs regular and random drug and alcohol testing for applicants and residents. We want the best for you and your baby and want mothers to be of sober mind while caring for their baby and while in the program. You can say yes to the following question and still be considered for the program.
Do you have a history of alcohol or drug abuse and if so, please tell us a little bit about it. (This includes marijuana)
*
Tell us a little more about yourself.
Have you lived in a maternity home before?
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Please choose one
Yes
No
What do you expect from New Beginnings?
*
What can New Beginnings expect from you?
*
Tell us more about why you are interested in a new beginning.
*
Do you believe this program is right for you?
*
Please choose one
Yes
No
We are currently full, click yes to be put on a wait list. Our wait list is good for up to 3 months, please reapply after 3 months if you are still interested in New Beginnings.
*
Yes
Submit