Apply for Assistance at Heaven’s Army

Whether you are facing physical, emotional, or spiritual challenges, our mission is to assist you and enrich your life in a meaningful way. Our programs are available to individuals regardless of race, creed, sexual orientation, or income level, and are offered free of charge to those willing to hear the Truth of God’s Word.

Complete the form below to apply for the help and resources you need to walk toward freedom.

Heaven's Army Application Form

If you are ready to take the next step toward a transformed life, please complete this application form. The information you provide will help us understand your needs and determine how our programs can best support your journey.

Please note: If this application is not complete with every question answered, it will NOT be accepted and will be disposed of.

Personal Information

Date of Birth (DOB)(Required)
Drive License State(Required)
Current Address(Required)
Last time you had your own place?(Required)
What are your reasons for enrolling in Heaven's Army? (check all that apply)(Required)
If accepted into our program, when would you be available for admission?(Required)

Emergency Contact

Emergency Contact Address(Required)

Marital/Relationship Information

What is your marital status?(Required)
How would you identify yourself?(Required)

Children/Dependant Information

Religious Background

What is your religious affiliation?(Required)

Medical Background

Educational Program

If YES, when did you receive it?
If YES, when did you receive it?
If YES, when did you receive it?
How many years did you attend in College?(Required)
If YES, what is the expected date of completion/graduation?

Criminal History

Select any options that apply to you in the PAST:(Required)
Select any options that apply to you CURRENTLY:(Required)
Include specific information: CRIME, DATE, LOCATION, OUTCOME

Chemical Background

Have you ever used/abused any of the following substances?(Required)
When was the last time you used?(Required)

Personal Development/Socialization

Program Expectations

Today's Date(Required)

Have Questions About Heaven's Army?

We are deeply committed to providing hope and support to those in need. If you're interested in learning more about our programs or how we serve others, feel free to reach out today!