General Information How did you hear about Youth-Reach Gulf Coast? * Are you aware that we are a Christ-centered home? * We believe that our only hope is freedom in Christ. Would you be open to exploring a true relationship with Jesus Christ, understanding that it may look different than church as you've known it? * List the locations (cities) you have lived in for the past three years. * How would you rate your attitude towards submitting to authority? * Please describe what your attitude towards submitting to authority has been recently. * Are you currently involved in a committed relationship (i.e. girlfriend, fiancée, wife, etc.)? * Do you currently have or support children? * During the last 12 months, how often did you have any kind of drink containing alcohol? * Do you or have you ever used recreational drugs? * If you answered yes to the above question, please explain which drugs you have used, what age you began using drugs and how often you have used drugs in the past 6 months. Criminal History Have you ever been charged with or convicted of a crime? * If you answered yes to the above question, please list all charges even if you have completed your time or probation. Have you ever been accused or convicted of a sexual offense? * If you answered yes to the above question, please explain. Do you presently have a criminal record? * Are you currently on probation or parole? * If you answered yes to the above question, please explain the offense(s) and explain the details of your probation. Do you have any upcoming court dates? * If you answered yes to the above question, please list the location(s), date(s)/time(s) and charge(s).