Residence Community for Working People

Open Doors Kalamazoo

APPLICATION FOR ADMISSION TO PROGRAM

This program is for adult men and women who are employed and who feel they could benefit from a residential living program that provides support, partnership, and accountability. Applicants in active addiction should seek treatment and gain some clean time before applying. Past addiction, past criminal convictions, credit problems, etc. will not prevent a person from being accepted into this program. We will ask about these things at the interview only so we can be more informed for partnership to help you succeed now and in the future.

Please answer all questions completely and accurately. Please print.

Your Name

First                                    Middle                                   Last

Today's Date _______          Your Social Security Number____ / ____ /______

Birth date: ____ / ___ / ______     Gender: Male Female

Marital Status: Single   Married   Divorced   Separated   Widowed

How can we contact you? Phone: ___________________________________

Address:_________________________________________________________

EMPLOYMENT INFORMATION

Where do you work? _________________________________________________

Address of employer __________________________________________________

What is your position or job title?________________________________________

How long have you worked with this employer? _____________________________

In the past 4 weeks, about how many hours have you worked per week?__________

What do you get paid per hour? ____________________

How did you hear about our program? ________________________________

Submit application to:

Property Manager Stephanie Hoffman at:

Next Door for Women         Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
1215 W. North Street         Phone: (269) 349-2119
Kalamazoo, MI 49006