And having been set free from sin, you have become the servants of righteousness • Romans 6:18

Sponsor One Weeks Rent Towards a Resident’s Stay at Indy Grace Place $63.00

Residency Application for Indy Grace Place

First Name:
Last Name:
Address:
City:	State: Zip Code:
Phone Number:	() -
Email:
Birth Date:
Marital Status:	Divorced Married Single Separated
Religion:
DOC Number:
Expected Release Date:
Previous Criminal Charges:	Date:
	Date:
	Date:
	Date:
	Date:
Status Upon Release:	Parole Probation Discharge
Highest Education Level:
Ever have a drug/alcohol problem?:	Yes No
Taking Any Medication?:	Yes No If yes, What:
What are your Future Goals:	^{What do you want to be doing in 5 years?}
EMERGENCY CONTACT
First Name:
Last Name:
Relationship:
Address:
City:	State: Zip:
Phone:	()