Application – Life Made New Ministries

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Application

To be considered for our discipleship program, fill out the form

Expectations

Your success in this program will be determined by what you are willing to allow God to change in your life. We will supply you with the tools and the opportunity; but the end result will be determined by what you make of that opportunity.

You will be assigned a bed
You are responsible for preparing your own meals
Clean up your mess & wash your dishes
Food in kitchen refrigerator is for everyone
If you’re not working, wash your clothes in the daytime
Transportation will be provided
Sign in/out when arriving/departing property
Must always have an accountability partner when leaving property
No drugs, alcohol or porn on LMNM property
No smoking or vaping inside home or garage

If you would prefer to download a printable application and mail it in,
DOWNLOAD HERE
and mail to:

Life Made New Ministries
C/O: Sam Harter
1224 S. Jefferson St.
Webb City, MO 64870

Apply for our program

Full Name *

Birth Date *

List any charges against you

Attorney’s Name

Next court date

What court?

What Time?

List those who have supported you (family, friends, etc.)

Last date of sobriety

Drug of Choise (alcohol, meth, etc.)

Are you currently employed?

Yes

No

If yes, where?

Are you able to work?

Yes

No

List skills, type of work you have done

Last job you worked

How do you feel you might benefit from our program?

How do you feel you might be able to help others in the program?

Have you been involved with any other programs?

Yes

No

If yes, which ones?

Are you on probation or parole?

Yes

No

If yes, Officer’s Name

Will you agree to a one year faith-based program?

Yes

No

Are you willing to get along with others in the program?

Yes

No

Do you feel you are teachable?

Yes

No

Are you able to pay a $250 deposit?

Yes

No

Do you understand you will pay a weekly program fees of $125?

Yes

No

Are you willing to participate in community service?

Yes

No

Are you willing to do daily chores assigned to you?

Yes

No

Do you have a driver’s license?

Yes

No

If no, what is needed to get one?

Have you ever committed a violent crime?

Yes

No

If yes, explain

Have you ever committed or been charged with a sex crime?

Yes

No

If yes, explain

Do you have the following in your possession?

Social Security Card

Yes

No

ID Card

Yes

No

Birth Certificate

Yes

No

What steps do you think you need to take to help make your life better?

Why do you think you should be accepted into this program?

1224 S. Jefferson St.
Webb City, MO 64870

Sam Harter
Founder/Director
417-499-1759

Kayla Harter
Associate Director/Counselor

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