Application Form Millie's House of Hope (MHOH) exists for women to experience a safe and peaceful living environment as they seek personal growth in Jesus Christ, and are supported through crises, to achieve a stable and thriving life. Resident Application First Name * Middle Name Last Name * Address * City * State * SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Contact Phone Number * Email * Date of Birth * Alternate Contact * What is the best way to reach you? Who referred you to MHOH? Please list any health conditions and diagnoses * Please list all medications * Would you be homeless if you couldn't come into the MHOH program? (Homelessness is not a requirement for acceptance.) *SelectYesNo Please read the following statements carefully. By checking the box you indicate that you have read, understand, and agree to each one. * MHOH is a faith-based Christian service where women learn how to live out Biblical based priciples, values, and disciplines taught per the Holy Scriptures. Such principles and disciplines include but are not limited to prayer, Bible reading and study, church attendance, and Christian outreach. * MHOH, a 501(c)3 non-profit, requires residents to obtain and maintain part-time employment. Since we do not require rent, but can accept charitable donations, we offer an opportunity for residents to give a standard 30% of income, as a suggested contribution to the ministry of Millie's House of Hope. * MHOH has a zero-tolerance policy for illegal substance use, alcohol use, nicotine use, and criminal or unholy behavior of any kind. Engaging in such behavior will result in immediate discharge from the home. * MHOH requires a clean urine analysis upon intake (this includes nicotine). MHOH will conduct random drug testing and room searches. * MHOH has a 30-day probationary policy and by signing this application you understand that we reserve the right to terminate your residency for any reason and at any time. * MHOH is a low-level care facility. We may decide that we cannot provide the level of care that you require or need. We reserve the right to refuse admission for any reason and will inform you if we decide to do so. Signature (please type your full name) * Our Vision That St. Louis County in Minnesota has accessible faith-based resources for women who have been violated, are homeless, or suffering from substance abuse. Our services will point them to Christ and assist them into stable and healthy relationships in an environment with zero tolerance for drugs or alcohol. Millie's House of Hope, an outreach and opportunity provided by: Duluth Harbor Rescue Mission PO Box 16282 Duluth, MN 55816 218-481-7400
