APPLICATION Do You Understand That Your Belongings Are Your Responsibility?
- Select - Yes No
(ALL MEDICATIONS MUST BE KEPT IN SELF-PROVIDED LOCKBOX)
Please explain what life situation has brought you to the House of Peace: (Eg. Relocation, Financial hardship, Lost my job, Evicted, Family Issues etc)
What are your life goals for the next 3 months and 3 years:
In 3 months I would like to…
In 3 years I would like to…
Please explain any criminal convictions in the last 10 years, and any drug or alcohol use or addiction recovery in the last 5 years.
HOUSE RULES
Personal Conduct
1.Maintain peace at all times with everyone.
2.Do not lie, steal or slander (gossip).
3.Absolutely NO drugs, alcohol, concealed weapons or unlawful behavior. Random drug and alcohol checks will be conducted.
4.Be respectful of others and speak politely. Look to grow yourself personally and professionally.
5.Network and participate in group activities of your choice as and when available.
6.Use headphones encouraged. 10pm to 6am is quiet time. Visitors must leave at this time.
Premises & Safety
7.Your belongings are your responsibility. Keep it safe.
8.Clean up after yourselves. Keep your belongings organized. Daily shower is required.
9.Be mindful that we are a temporary housing facility. Bring only what you need on a daily basis eg. Clothes you use often, toiletries, books etc. and get a storage locker if you need nearby. Your belongings should fit under your bed, in your closet or shelves assigned to you.
10.Weekly inspections will be conducted of the living space and fines issued if not well kept.
11.Host or authorized personnel may enter your room at any time for ensuring safety, security and cleanliness of the premises.
Payments & Move Out
12.Cashier’s Check or Money Orders payable to “House of Peace – Monroe” is the only accepted form of payment. NO CASH or personal checks. Late payments have a 5% penalty.
13.If you are unable to pay your dues ask for any available assistance or alternate shelter options.
14.When you are ready to move out please clean your room/bed area. Leave the key in the door or hand it to the Sargent. Fill out the exit questionnaire for a souvenir.
15.If you are removed from the facility or asked to leave due to your violation of house rules your belongings have to be removed immediately. No refunds for unused portions of fees paid are available. After 30 days any remnants will be donated to thrift stores in our community.
16.If you are asked to leave and you do not remove yourself and your belongings you will be billed a market rate of $60/day and if you appear to threaten the peace of the house will be handed over to law enforcement.
By signing below, I acknowledge that I understand admission to the House of Peace is a privilege and can be revoked at any time without any cause and further agree to the above terms and conditions.
Thank you for your interest in the House of Peace. CONDITIONS OF TEMPORARY HOUSING
Please read and accept:
Hardship assistance has to be applied for in advance and your House Council should be able to guide you on the availability and approval procedures.
The House has no control over the availability of funds or your eligibility and you can always come back when it is approved.
Violations due to alcohol or drug use has no grace period. You have to vacate the premises immediately upon notice.
WAIVER OF LIABILITY
Please read and accept
PERSONAL INCOME/EXPENSE STATEMENT (If applying as a family, please include all income producers in the family.)
List All Sources Of Income
Monthly Earnings From All Sources
Monthly Expense Sources & Amounts
By signing below, I certify that the information provided in this income/expenses statement is true and correct.
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