Pre-application
Pre-application
There are two options to submit your form. First, you can click one the link below, print it, fill it out, and bring it to Matthew 25 at
Matthew 25 Vine Hill Towers 625 Benton Avenue, Box 120 Nashville, TN 37204Printable Version OR Fill out the form online below and click submit.
Because you are submitting it online, you will be required to provide a social security number and signature in person.
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Are you a Veteran?
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Yes No |
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Name:
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Date of Birth:
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Race:
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Age
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Referral Agency:
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Current Residence:
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Where did you sleep last night?
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How many times have you been homeless in the past three years?
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Once Twice Three times More |
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Have you previously been a resident of Matthew 25?
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Yes No |
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If YES, how many times?
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When was the last time you were here?
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Place of employment:
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How long have you been employed there?
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Employment Address:
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Employer’s Phone Number:
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Is this a full-time position?
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Yes No |
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Contact Person:
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How much do you make an hour?
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$ |
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Next Payday:
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Do you receive SSI/SSD or VA benefits?
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Yes No |
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If YES, how much?
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Have you applied for any of the above benefits?
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Yes No |
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Have you been in an alcohol or drug treatment program?
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Yes No |
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If YES, how many times?
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When?
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Where?
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Drug of choice?
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Last time you drank or used?
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| I have read the IMPORTANT THINGS ABOUT MATTHEW 25. If accepted, I will live up to all the things written. I AGREE TO PAY THE $10.00 PER DAY PROGRAM FEE WITH THE UNDERSTANDING THAT ONE-HALF OR $5.00 WILL BE RETURNED TO ME IF I “SUCCESSFULLY” COMPLETE THE FIRST 30 DAYS OF THE PROGRAM AND $7.50 WILL BE RETURNED TO ME AFTER “SUCCESSFULLY” COMPLETING THE SECOND 30 DAYS. THE PROGRAM FEE WILL BE AUTOMATICALLY DEDUCTED FROM DEPOSITS MADE INTO MY ACCOUNT. | |
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I Agree
I do Not Agree |
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| HOW THE PROGRAM FEE WORKS PROGRAM FEE YOU GET BACK M25 Amount Your Amount 1st 30 days: $300 ($10 X 30 days) $150 returned = $150 /$150 2nd 30 days: $300 ($10 X 30 days) $225 returned = $ 75 /$225 3rd 30 days: $300 ($10 X 30 days) $300 returned = $ 0 /$300 I WILL DEPOSIT 75% OF EACH DOLLAR I EARN, AFTER LEGAL OBLIGATIONS. I WILL REMAIN ALCOHOL AND DRUG FREE WHILE IN RESIDENCE AT MATTHEW 25. I WILL NOT COMMIT ACTS OF VIOLENCE OR MAKE THREATS OF VIOLENCE.Before clicking submit, please review the form and be sure that all applicable fields are completed and that all of the information is correct. | |
