Enhanced Horizons Transitional Living Program Application

Enhanced Horizons Transitional Living Program

Thank you for your interest in Enhanced Horizons (EH) Center for Advancement. The Enhanced Horizons transitional living program is designed to help teens and young adults move toward self-sufficiency and successful adult living (this includes single mothers with children).

By providing housing, transportation, and other services, each young adult is given an opportunity to develop and work on individualized independent living goals in a positive, safe, and supporting living environment.

How long is the program? The length of time in the Enhanced Horizons program varies depending on the individual needs of the young adult. To obtain maximum benefit from the program, we anticipate that most residents will stay anywhere from nine (9) to twenty-four (24) months.

What is expected of residents? All residents will be required to:

Participate in the development of a personal service plan that outlines the goals and objectives that they hope to accomplish while in the program.

Engage in a minimum of thirty-five (35) hours per week of productive activities, such as attending school, working a full-time or part-time job, community service, and/or independent living skills training.

Will be expected to actively seek employment and to work at least part-time. Residents will pay a small portion of their paycheck for living expenses and will be expected to save funds during their stay at Enhanced Horizons.

Follow program guidelines and expectations.

What does it take to succeed in the program? Participants must have a certain level of maturity and a strong willingness to work with program staff and other residents to accomplish their individual program goals and objectives.

What are the eligibility requirements? To be eligible for the program, you:

Must be 18 to 24 years of age.

Must be in need of a dependable, safe place to live.

Must be committed to actively participating in EH program services.

Must be willing to follow program guidelines and expectations.
Note: Couples and/or on-campus romantic relationships are not allowed.

What are the application requirements?Applicants must submit the following:

An Enhanced Horizons Application Form

An Enhanced Horizons Release of Information Form to obtain educational, medical, and other relevant records.

A consent form for a Criminal History Check.

Enhanced Horizons Application
It is the policy of Enhanced Horizons (EH) and Hill Country Youth Ranch (HCYR) not to discriminate on the basis of race, color, national origin, sex, age, or handicap in its programs, services, activities, and employment practice as required by Title VI of the Civil Rights Act of 1964, as amended, Title IX of the Education Amendment of 1972, and Section 504 of the Rehabilitation Act of 1973, as amended. Enhanced Horizons will take steps to assure that lack of English language skills will not be a barrier to admission and participation in all residential, educational, and vocational programs. Contact Mike Wood, 149 Camp Scenic Loop, Ingram, Texas, 78025, phone (830) 367-4330 for information about your rights or grievance procedures.
Application Instructions
If you need assistance in completing this form, our staff is glad to assist you.

Please answer all questions as honestly and as accurately as you can. if you have any questions, please call us at (830) 367-4330 ext. 229 for assistance.

For driving directions to Enhanced Horizons, call (830) 367-4330 ext. 229.
Full Name
First Name Middle Name Last Name
Maiden Name and/or Other Legal Names by which You Have Been Known
Date of Birth
Date Format: MM slash DD slash YYYY
Age
Phone Number(s)
Email
Current Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Part I: Referral Source
If you were referred to EH by someone in an organization, please provide the following information:
Name of Organization Name of Contact Person Phone Number
If you were referred to EH by someone you know personally, please provide the following information:
Name of Person What is their relation to you? Phone Number
If no agency or person referred you, how did you learn about Enhanced Horizons?
Part II: Living Situation
Where do you currently reside?
How long have you lived at your current residence?
Where did you live before your current place of residence?
Over the past year, where have you lived the longest?
Part III: Education
Highest grade you have completed in school:
- Less than Grade 5
- 5th
- 6th
- 7th
- 8th
- 9th
- 10th
- 11th
- 12th
If you did not complete elementary or high school, please indicate why.
- I dropped out.
- I was suspended.
- I was expelled.
Do you have a high school diploma?
- Yes
- No
Did you complete the GED?
- Yes
- No
Have you taken college courses?
- Yes
- No
Are you currently attending school?
- Yes
- No
If you are currently attending school, please complete the information below.
Name of School Hours Attended Per Week
What is the name of the last school that you attended?
Name of School Did you attend full time or part time?
Part IV: Work, Financial Status, and Transportation
Are you currently Employed?
- Yes
- No
If Yes, please list the name of your current employer(s) and indicate the number of hours you work per week at each job:
Name of Employer Hours Worked Per Week
If you are NOT working, please check the statement below that best describes your current situation:
- I am not employed and am actively looking for employment.
- I am not employed, because I am in school.
- I am unable to work due to a physical disability, a developmental disability, or an illness.
- I am not employed and am not currently looking for work.
What are your other sources of income or public assistance? (Check all that apply.)
- Child Support
- Food Stamps
- Medicaid
- Medicare
- Scholarships
- Federal Financial Aid through a college or university
- Personal Savings or Checking Account
- Money from Friends and/or Family
Other sources of income not listed above:
Are you currently in debt?
- Yes
- No
If you chose Yes above, please explain what type of debt and the amount owed.
Please indicate your current means of transportation. (Check all that apply.)
- I own my own car/truck/motorcycle
- My friends/family take me places
- I ride with a coworker or fellow student to get to and from work and/or school
- Transportation is provided by either the place I live or the place I go to school.
Please list any other means of transportation that you use:
Part V: Social History
Have you ever been in trouble with the law?
- Yes
- No
If Yes, please explain:
Have you ever been arrested?
- Yes
- No
If Yes, please explain:
Have you ever had trouble with drugs or alcohol?
- Yes
- No
If Yes, please explain:
Have you ever received counseling?
- Yes
- No
If Yes, please explain:
If yes, was counseling helpful?
- Yes
- No
Part VI: Medical/Mental Health History
Have you had any serious illnesses during the past five (5) years?
- Yes
- No
If Yes, please describe:
What is the present state of your physical health?
- Good
- Fair
- Poor
Please list any physical problems or conditions that you may have:
Please list any medications that you are currently taking and the reason for the medication (including birth control).
Part VII: Marital and Family
Are you:
- Single
- Married
- Divorced
- Separated
Are you expecting a child?
- Yes
- No
If Yes, when is the due date?
Doctor's Name
Do you have children?
- Yes
- No
If Yes, how many children do you have?
Please provide the following information about your children.
Name Date of Birth Girl / Boy Do you have custody?
Do any of your children have medical problems?
- Yes
- No
List any medications your children may be taking and the reason for the medication.
Child's Name Medication Reason
Part VIII: Personal Statement
Please tell us why you would like to enter the Enhanced Horizons program. What are your personal goals and how can this program help you achieve your goals?
Contact Patricia Neal, 149 Camp Scenic Road, Ingram, Texas 78025, phone (830) 367-4330 ext. 229.

Enhanced Horizons Transitional Living Program Application

Enhanced Horizons Transitional Living Program

Enhanced Horizons Application

Application Instructions

Part I: Referral Source

Part II: Living Situation

Part III: Education

Part IV: Work, Financial Status, and Transportation

Part V: Social History

Part VI: Medical/Mental Health History

Part VII: Marital and Family

Part VIII: Personal Statement

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First Name	Middle Name	Last Name

Name of Organization	Name of Contact Person	Phone Number

Name of Person	What is their relation to you?	Phone Number

Name of School	Hours Attended Per Week