Rapid Application

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What counties are you applying for? Prices are program fees per month for the respective counties.
Name
Are you a veteran?
Are you currently on DOC supervision?
Have you ever applied to HOM in the past?
Either self or family member
Either self or family member

Section A: Currently Incarcerated

If the applicant is not currently incarcerated, feel free to advance to Section B.
Eligible for DOC Voucher Program?

Section B: Not Currently Incarcerated

This applies to the applicants who are not currently incarcerated, even if you have previous felony convictions.
Relationship with the applicant
Complete if someone other than the applicant is filling out this application.
Give a brief explanation of your current living conditions, whether it be homelessness, living with a friend, out of your car or otherwise. Please include the city you reside in.

Section C: Criminal and Health History

Please complete the application to the best of your abilities and be thorough and honest. Please note, we are looking for an honest and complete disclosure of all criminal history. Your criminal history will not cause you to be denied, however withholding information will be grounds for denial of application.
Security Threat Group
(STG, or Gang Affiliations)
Do you have medical conditions?
Do you have any history of mental illness?
Are you currently under the care of a mental health counselor or therapist?
Have you ever abused drugs or alcohol?
Prior substance use disorder treatment?
ISRB: (Intermediate Sentencing Review Board )
Sex Offender Level (if applicable)
Stipulated Agreement: Please read and check off each of the following stipulations as an indication of agreement. If accepted in the program, you will be expected to sign a document similar to this.
Please read and check off each of the following stipulations as an indication of agreement. If accepted in the program, you will be expected to sign a document similar to this.
Date / Time