Program Application

The program application gives us information about you, your interests and your needs. The information helps us evaluate resources you might need and referrals the program might be able to make outside of Jeremiah Program.

Much of this information is confidential and may be used by us to determine how to best serve your needs and those of your family. If you are uncomfortable with any question, you may omit answering it. You may also contact the Admission Coordinator’s office at 651-332-5017 for more information about any question or how this information is used.

Applications are reviewed as received. Please understand that our program is not an emergency shelter. Those families that meet the applicant criteria may be invited for an interview. After completion of the interview, candidates may be invited to participate in the pre-admissions process including a 16-week Empowerment training course, pre-admissions coaching and documentation collection. Pre-admission participation is a requirement for acceptance to the program. Upon successful participation in pre-admissions, an applicant may be invited to an admissions interview. The admissions decision is final. Actual admission for housing is based on unit availability/occupancy. Jeremiah Program reserves the right to close applications at any time.

Minneapolis St. Paul Online Program Application

Applicant Information

Applicants may indicate a preference for either the Minneapolis or Saint Paul campus; however, there is no guarantee that preferences will be honored. Please check your preference below.
Include: Apartment, Suite or Unit #
*Long-term homelessness is defined as someone lacking a permanent place to live continuously for one year or more, or at least four times in the past three years or less. This can include staying in a shelter, a place not meant for habitation (e.g., a vehicle, an abandoned building, bus/train station/airport or anywhere outside), or couch hopping.
Enter your contact info and indicate whether we can contact you using the information you entered.
You may enter more than one if necessary

Children's Information

Current children in the household:

Custody Arrangement

Employment

Income Information

What are your current monthly sources of income?

Educational Information

* Please keep in mind that in order to qualify, you must be accepted to or enrolled at a postsecondary institution (seeking either an associate’s or a bachelor’s degree) that is accredited by the Higher Learning Commission and on our List of Approved Post-Secondary Institutions (can be found on our website).

Health Information

Why Jeremiah Program?

Jeremiah Program is committed to compliance with all local, state, and federal civil rights and human rights laws that prohibit discrimination in providing educational, social service, and housing opportunities. Jeremiah Program does not discriminate against any applicant or participant on the basis of race, color, religion, creed, national origin, marital status, familial status, status with regard to receipt of public assistance, physical or mental disability, or affectional preference.

Jeremiah Program does provide reasonable accommodations for persons with disabilities. Reasonable accommodations in rules, policies, practices, and services will be allowed to give persons with disabilities an equal opportunity to use and enjoy housing provided by Jeremiah Program or to participate in other aspects of the program, provided such accommodations do not impose an undue hardship on the organization. Applicants or program participants with disabilities seeking reasonable accommodations must contact the Executive Director to make an accommodation request.

By dating this application, I agree:

The information in this application is true and correct. I hereby grant permission to Jeremiah Program to seek the release of personal information concerning me from sources reported in this application including, but not limited to: government agencies, educational institutions, current and former employers, health care providers, and mental/chemical health facilities. I understand that my signed consent below will operate as consent for the purposes of complying with the Health Insurance Portability and Accountability Act of 1996, the Family Educational Rights and Privacy Act, the Federal Privacy Act of 1974, and the Minnesota Government Data Practices Act.

 

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