I. Background Information
NOTE: The following information is used for statistical purposes only
NOTE: This information is for us to help you budget and will not keep you from being accepted
NOTE: Having past/present legal problems will not automatically exclude you from the program
XI. Substance Use
NOTE: This information is confidential and may not exclude you from admission into Hannah's Home
XII. Pregnancy Information
NOTE: Hannah’s Home does not have the medical personnel to monitor the administration of psychotropic drugs. If you are on these medications, we will need a note from your attending physician stating that you are able to function daily while off these medications.
XVI. Essay (Please answer the following questions fully and truthfully)
I have accurately indicated all of the information pertaining to my situation, condition, and family needs. Any falsified information may cause my application and/or subsequent acceptance to be re-evaluated and/or suspended.