What church do you attend?_________________________________
Name and address of your pastor_________________________________________________
Phone Number of your pastor________________________________
The Christian Discipleship Center is primarily a spiritual program based upon the Bible, Godís Word. Do you desire Godís answer to your problems, and are you willing to follow what you will learn from the Bible?_______________________________________________
Please Answer the following questions:
Y N Are you having financial problems?
Y N Are you having marriage problems?
Y N Are you having family problems?
Y N Are you having court problems?
Y N Are you having problems knowing if you are saved (a Christian)?
Y N Have you ever attempted suicide?
REQUIREMENTS FOR ADMISSION:
Our program is being offered at minimum cost to you and is supported by the gifts of those interested in the program. All successful applicants must commit to the following requirements.
Check each one and sign below:
1_____ That you will remain in the program for a period of 90 days.
2_____ That you are not allowed to leave the grounds without a staff member present.
3_____ That for the first TWO weeks there will be no communication with anyone outside the program (except for emergency).
4_____ That you will make an effort to apply yourself in all phases of the program.
5_____ That you will abstain from all alcohol, drugs, and tobacco.
6_____ That you will submit to the authority and direction of the staff.
7_____ That you will commit yourself to daily Bible reading, study and prayer.
8_____ That you will consent to a search of your person and possessions when you arrive and anytime while you are in the program. (Items forbidden in the handbook will be taken away).
9_____ That you will consent to random alcohol and drug testing while in the program.
10.____ Any violations of the rules will be grounds for discipline and/or dismissal.
The Fee for the CDC program applies only to the housing and meals. The Recovery Program (instruction, counseling, materials, etc.) is subsidized through donations, and our staff offer their services without charge to CDC.
If a client self-pays, there is a subsidized Program Fee of $400 per month or $1200 for the complete 90 days (The Actual Cost is $2100 for 90 days; a scholarship of $900 is included in self-pay).
The following are sources of income which enable a client to contribute toward the Program Fee for his enrollment:
Employment Income __________
SSI or SSDI Monthly Income __________
Tribal Allotments, Dividends __________
Contribution by family __________
Contribution by church or sponsor __________
If any or all of the above amounts are equal to or greater than the $400 per month for the room and board charges, the Client will pay the Program Fee of $1200 for enrolling in the program.
If a Tribe or other government or health agency is paying for the clientís enrollment, an invoice must be mailed directly from CDC to such agency, and the full, unsubsidized Fee (Actual Cost) of $2100 will be assessed.