Good Shepherd Gracenter
Good Shepherd Gracenter Introduction Form
  1. Name:(*)
    Please let us know your name.
  2. Age:
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  3. Date:
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  4. Phone Number:
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  5. Your Email(*)
    Please let us know your email address.
  6. Are you willing to join a community of women in residence to support each other in maintaining recovery and other common goals?
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  7. Are you willing to develop follow through with an individual recovery plan and participate in recovery monitoring, case management, 12-step program, and other supportive services?
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  8. Are you willing to seek and maintain employment, job training, education, or volunteer work?
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  9. Are you willing to join a community of women in residence to support each other in maintaining recovery and other common goals?
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  10. Tell us something about [1] yourself and your recovery and [2] why you are interested in Gracenter's program.(*)
    Please let us know your message.
  11. Security:(*)
    Security:
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