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Acceptance Criteria

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  1. Applicants must be women 18 years of age or older.

  2. Women with children under the age of 10 are eligible.

  3. Applicants must have no active arrest warrants.

  4. Applicants must have maintained sobriety from drugs and alcohol for at least one year.

  5. Applicants with a history of violence, theft, or mental health needs requiring medication will be considered on a case-by-case basis.

  6. Applicants must be willing to seek and maintain employment while participating in the program.

  7. Applicants residing outside Lancaster County will be considered on a case-by-case basis.

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Residential Program Application

Personal Information

Ethnicity
White/Caucasian
Black/African American
Asian
Indigenous/Native American
Hawaiian/Pacific Islander
Hispanic or Latino
Prefer not to say
Do you have a personal vehicle?
Yes
No

If working with a housing provider, please provide their contact information.

Children

Please fill out the following for each child that will be living with you. ** If you do not have children, please leave blank.

Gender
Gender
Gender
Gender
Do you have childcare?
Yes
No
Are you enrolled with Child Works/ELRC (Early Learning Resource Center)?
Yes
No

Housing History

Have you ever been a participant in our program before?
Yes
No
Did you speak with 211?
Yes
No
Have you ever experienced homelessness before?
Yes
No
Do you have any evictions?
Yes
No
If yes, how many, if none please select none.
None
1
2
3 or more

Health and Well Being

Are you pregnant or think you may be?
Yes
No
Are you currently using or have used in the last 12 months any illegal substances or are you struggling with alcohol?
Yes
No
Were you recently in a hospital or rehab?
Yes
No
Will you need ongoing care?
Yes
No
Do you require any ADA accommodations?
Yes
No
Do you have any past substance or alcohol abuse?
Yes
No
Do you have any mental health diagnoses?
Yes
No
Are you currently fleeing domestic abuse?
Yes
No
Do you have a PFA against someone?
Yes
No
Is there a PFA against you?
Yes
No

Financial and Legal History

Are you currently employed?
Yes
No

Please list what you receive MONTHLY for each category below.

Do you have any debt?
Yes
No
Are you on Megan's law?
Yes
No
Do you have a criminal background (charges or convictions)?
Yes
No
Do you currently have any arrest warrants?
Yes
No
Were you recently incarcerated?
Yes
No
Are you on probation or parole?
Yes
No
Are you a resident of Lancaster County?
Yes
No
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Manheim community life group is a 501(c)(3) nonprofit organization- contributions to which are tax-deductible to the fullest extent permitted by law.
 

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