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Victory House

Victory House Application Form

FULL NAME

Please print first, middle, last name. Also include maiden name or previous married names.

First Name

Last Name

DATE OF BIRTH

YYYY

CURRENT ADDRESS

LAST PERMANENT ADDRESS

CONTACT NUMBER

(###)

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HOW DID YOU HEAR ABOUT US?

SPIRITUAL BACKGROUND (What have you done recently to build your relationship with Christ?)

Please include any Bible studies, church attendance, etc.

Have you attended a church or Bible study program on a regular basis? Please explain and list below. Provide the name of the church, or group, and a contact person at the church (name and phone number).

Do you have a denominational/church preference?

Please explain the importance of Prayer and Bible reading in your spiritual life

Do you have a relationship with Jesus Christ? Please write your personal testimony and include why you desire to make behavioral changes in your life based on your relationship with Jesus Christ?

RECOVERY/TRAINING/SPIRITUAL PROGRAMS

Please list any type of recovery, spiritual or training programs that you participated in while incarcerated/ treatment and/or upon release.

Have you participated in Christ-Centered Recovery (Celebrate Recovery) before? And, if yes, when?

Are you willing to participate in Christ-centered recovery?

If you have been in a transitional/ recovery house before, please provide the name of the facility and the time period you were there.

Did you complete the program?

What was your reason for leaving?

FUTURE GOALS

Briefly tell us what your goals are for the future and how you hope to accomplish them. (Ex. Work, school, dreams that have been set aside in active addiction)

Explain your current needs for transitional housing and what you hope to gain from your time at Victory House.

CRIMINAL BACKGROUND (How many convictions have you had?)

What charges were you convicted of?

Have you ever been charged with anything requiring you to register as a sex offender? Yes or No

When is your anticipated date of release?

Will you be or are you currently on probation or parole?

Do you know how long or what your requirements will be? If yes, please explain

FAMILY BACKGROUND

Current wife/ husband (legal marriage only)

Contact Number

(###)

###

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Complete Address

How would you describe your relationship with him/her?

Describe your support system. (family or otherwise). Please include where they are located.

Do you have children? If so, please list names, ages, sex and identify their current caregivers. (Victory House cannot accept children as residents.)

Have your parental rights been terminated?

EDUCATIONAL BACKGROUND (What is the highest level of education you have completed?)

G.E.D.? If yes, what year did you get your G.E.D.?

If no diploma or G.E.D., do you need help to get one?

EMPLOYMENT INFORMATION

Please provide a brief employment history.

What employment skills do you have?

(Ex. Cooking, driving, office, hospitality, customer service, house cleaning)

Do you have any physical ailment, injury or handicap that would prevent you from performing work-related tasks, doing housekeeping chores or obtaining employment? If yes, please explain.

Are you disabled? If yes, do you receive benefits?

MEDICAL HISTORY (Do you have any medical conditions that would prevent you from actively participating in the program?)

List any current medications you are taking and explain why.

Please indicate if you have had or currently have, any of the following: (Seizures, Tuberculosis, HIV, Transfusions, Ear Problems, Hepatitis, Epilepsy, Diabetes).

Kindly indicate if you are unsure if you have/had it or not.

If you've had any of the following above, please indicate which type and explain as much as you can below, for both yes and unsure answers.

MENTAL HEALTH (Do you have any mental conditions or learning disabilities that would prevent you from participating in the program?)

If you are currently being treated or have been treated in the past for a mental or emotional disorder and you do not disclose your information below, this could be grounds for dismissal. The RecoveryChick program is not equipped to provide professional mental or health services.

Are you currently taking any psychiatric medications? If yes, please explain.

Have you ever been diagnosed or treated for any of the following: Mental Illness, Attention Deficit Disorder, Anxiety Disorder, Bipolar, Borderline Personality Disorder, Depression, Eating Disorders, Obsessive-Compulsive Disorder, Paranoid Personality Disorder and Schizophrenia?

If yes, please indicate which type or if others, please specify.

If your answer is yes or unsure, please explain further.

List of any Psychotropic Drugs used in the past or anticipated future use or need:

HISTORY OF DRUG OR ALCOHOL ABUSE (Which drugs/alcohol have you used in the past and with what frequency?)

Date of your last drink/drug use.

Do you agree not to use any drugs or alcohol while residing at Victory House? Yes or No.

FINANCIAL (How will you pay for your stay while at Victory House? )

Are you eligible for or receiving the following: SSI, Disability Benefits/SSD, Food Stamps? If others, please specify.

If someone, other than the resident, will be responsible for, or pay any portion of fees to Recovery Chick, please list the individual's information below:

Billing Address

Contact Number

RECOVERY SERVICES

I understand that any recovery services offered at Victory House are exclusively Christ-centered in nature and are not subject to licensure or regulation by the Texas Commission on Alcohol and Drug Abuse. This program offers only non-medical treatment and recovery methods such as prayer, Christian 12-step study, moral guidance, spiritual counseling, and scriptural study.

RELEASE INFORMATION

I hereby authorize the release of information to RecoveryChick to receive the assistance I am requesting. I further certify that all the information on this application is true and correct. I understand that RecoveryChick may verify the information on this application and that deliberate misrepresentation of information may deny me acceptance to the program at RecoveryChick. I give RecoveryChick permission to discuss my case with other agencies, businesses, churches, attorneys, individuals, and any others deemed necessary to verify application information and/or identify additional sources of assistance. I understand that all information will remain as private as possible within these entities. I have read, understood, and agree to the policies above regarding the Release of Information.

Victory House is our third sober living home offering women a safe and healthy place to recover. RecoveryChick House 3 (Victory House) opened in 2024 and is located at Galveston, Texas. This is an exciting addition to our ministry for women who are willing and able to work a program of recovery.

IT ALL STARTED WHEN…I needed to find someplace to live after treatment. My sister’s house was safe, but I was rebellious. I loved Jesus but I had never lived in the free world without drugs in my body and there was too much water under the bridge with my family. I needed to get around other people like me, people in recovery. My first Oxford House was a true blessing, but I had to navigate my faith on my own. My housemates didn’t understand why I lived according to Biblical principles and often gave me a hard time about it. I dreamt that someday I would develop a program offering women a place to live their faith and their recovery out loud.

Today that dream is a reality.

Welcome to Precious Rubies.

how it works

The women live in a single residence as a family and are learning to live life, on life's terms. We have a team of community mentors volunteering their talents and time to teach life skills, work ethic, Biblical principles on identity, prayer, faith, purpose, and more! All of this coupled with the proven 12 Steps of traditional recovery.

The women of Victory House Galveston are learning the importance of being a productive member of our community and how to add value to our beloved Galveston! Why are we having so much success? We stand on the Word of God. Period.

The women are daily learning scriptures and renewing their minds in the Word. Whatever our minds tell our hands to do, they do. Wherever our minds tell our feet to go; they go. If we get our mind right, the body follows. We treat addictions as a spiritual problem with a spiritual answer. If they have Jesus leading their life they can overcome temptations leading to relapse. They stick and stay. They allow the process to transform them into who God has called them to be! They are gaining confidence in recovery and faith, working out and working jobs. All have quit mind-altering substances completely, all have opened bank accounts, and all are learning the value of being a productive member of society!

qualifications

Minimum 30 days of continuous recovery.

Willingness and ability to work a program of recovery including 12 Step Meeting’s.
Completely free of all mind altering substances and agree to random drug tests.
Ability and willingness to attend groups and classes with a good attitude.
Follow house rules and policies.
Be self-supporting. $200 Sober Fee, and $750 monthly dues.

Welcome to VICTORY HOUSE

Hello Beautiful RecoveryChick,

We have been praying for you and we are glad you are here. You are not alone. RecoveryChick's have been where you are, and we are here to boldly proclaim people like us do recover!!

We are a breed of broken people who are in the process of being transformed. We are not ashamed to tell our story and not ashamed of Jesus. We are putting a purpose to our pain. We are sharing our lives with others so they too can be free. When He sends us, we will go. We are applying recovery principles to every area of life and living a life we never could've imagined.

We are recovering from anything that’s keeping us from living our God-given purpose and destiny. We are stepping out of denial and into God's grace. If this resonates in your Spirit and you are ready to do the honest work of recovery, we invite you to fill out this application and come to live with us in this Christ-Centered recovery community.

“For I know the plans I have for you,” says the Lord. “They are plans for good and not for disaster, to give you a future and a hope.”

- Jeremiah 29:11 Life Recovery Bible

Looking forward to meeting you,

Pastor Cynthia Corder

Founder, Executive Director