• First 2 weeks at the Gateway, no visitation, and no phone calls.
(No visitation in the family section at any time).
• Must turn in cell phone while at the Gateway for 30 days.
• CLIENTS MAY NOT LEAVE THE FACILITY unless accompanied by a STAFF MEMBER during the entire stay at Gateway Freedom Center, or approved by director.
• Clients will be allowed two ten minute phone calls per week. One on Tuesday and one on Saturday, after two weeks. Any emergency phone calls will be handled by staff. Clients CANNOT have or use cell phones on the inside or outside premises (depending on the program) including visitor's cell phones, beepers, pagers or laptop computers.
• Television may be viewed from 8:00 AM until 11:00 PM 7 DAYS A WEEK.
• Must attend Bible Study nightly at Gateway from 8:00pm to 8:30pm.
• Must attend Church services and Bible study at Bethel Power of Faith Ministries.
• Must pay $50.00 to $75.00 weekly rent. (Based on Income).
• Doors are locked at 9:00pm nightly, No re-entry after 9:00pm.
• Probation clients depending on the program must be in before 6pm.
• Please do not remove mail from the mailbox. Mail will be collected and distributed.
• If you are not working you are required to be in by 9:00pm.
• No loud noise after 10:00pm.
• No HATS OR HEAD DRESS will be allowed inside facility.
• No eating or drinking on the entire 2nd Floor, or in the Family section.
• Fighting at the Gateway is an automatic dismissal for both parties.
• Exiting the building or property without permission is an automatic dismissal.
• After 3 write-ups in 2 months for arguing, profanity, disobedience, and not coming in on time, you will be dismissed from the Gateway.
• Gateway is a Smoke, Alcohol, and Drug free facility. Designated smoking areas will be identified.
• Any client whose residency has been terminated for any cause may not return to the facility except to pick up personal belongings, and then only if client is alcohol/drug-free. Personal belongings not picked up within ten (10) days will become Gateway property.
• ABSOLUTELY NO FOUL OR PROFANE LANGUAGE IS ACCEPTABLE AND WILL NOT BE TOLERATED!
• GFC STAFF MEMBER will go to the grocery store two times a week, on Tuesday’s and Friday’s ONLY FOR THE CLIENTS. List of items wanted, and money to purchase must be turned in by 9am on each morning. GFC will buy for the house if clients do not have money.
• Our programs are for 28 days, 3 months, 6 months, and 1 year of treatment and rehabilitation. Each client must agree to remain in the facility until the 28 day program assigned is completed, or unless approved by the Executive Director.
• Co-operation from each client is mandatory, when asked to do a chore, participate in an activity (scheduled or unscheduled), or any reasonable request by any STAFF MEMBER, all clients are expected to comply!
• No client will sit or lie down on beds between 8am & 6pm (Mon- Fri) unless approved. At no time will any client lay/stretch out on sofas. Nor shall any client drape their legs over the arms of sofa’s or chairs.
• Will have chores during the week such as cleaning, cooking, and volunteer work at the Gateway.
• Must attend support groups meetings, classes, and activities during the week.
• Must wash clothes once a week, which includes bed linen.
• Must schedule your appointments and advise the Gateway of dates and times.
• Must sign in and out at the security desk.
• No visitors in the living quarters.
• You are responsible for purchasing food, laundry detergent, and hygiene products.
• All Bags, and luggage will be checked at the initial check-in.
• Visitation on Sunday’s from 6:00pm – 8:00pm after initial 2 week period (30 mins).
• During business hours, (8:00am to 5:00pm) please sign out, in, and exit from the side door entrance to the parking lot.
• If you have any questions, or concerns please contact the Director, or Staff Member.
• ALL MEDICATION (PRESCRITION OR OVER THE COUNTER) must be turned over to SECURITY when admitted. No cough medicine, or pills used, will be distributed at the Gateway (Aspirins, Advil…) except through security, and pills must be counted and signed for it prescription or over the counter, if not in new bottles it must be discarded. All clients are responsible for requesting medication at the prescribed times.
• No visitation in the rooms among residents.
• Hygiene: Must shower daily.
• Must seek employment daily from 10:00am to 2:00pm.
• Two 24-hour passes per month provided after 2-month to 9-month probationary period (depending on /probationary requirements), but you must contact the director.
• Dinner is served from 5pm - 6pm. Kitchen will be closed at 8pm. Water will be available until 11pm. Cooking during the week will be shared by others.
• Two 24-hour passes provided per month after 30 days, pending approval.
• Must be up, showered, dressed, and eaten breakfast by 8:00am.
• High heel shoes are not permitted on the stairway.
• If Drugs or Alcohol are used, the board will decide if this will be an automatic dismissal from the Gateway.
• Must consent to random drug testing.
• Borrowing between clients IS NOT PERMITTED. See your counselor if you have a need.
• THERE WILL BE NO GAMBLING ALLOWED, OR SELLING OF PERSONAL ITEMS.
• Dress Code: Jeans/Slacks, Shirt with Sleeves, knee length shorts/Capris and shoes. Clients must keep something on their feet at all times except when in their bedroom. Shorts must be knee length. All clients shall dress in a manner which will not embarrass themselves or others at all times. NO TANK TOPS/SLEEVELES TOPS WILL BE WORN AT ANY TIMES.
• If any of these rules are broken, you will be written up.
• If given 3 write-ups within 2 months you will be dismissed from the Gateway.
• 1st Write Up: A warning will be given.
• 2nd Write Up: You will go before the board. • 3rd Write Up: You will be dismissed from the Gateway.
Admission procedures and requirements • All applicants must be interviewed before acceptance into the Gateway Freedom Center Transitional housing program.
• Must have social security card and driver’s license or state ID
• On the first day of admission new residents will complete an intake with a Gateway Counselor.
• Must agree to participate in Transitional program for a minimum of three months.
• All applicants for admission shall be required to provide a complete set of treatment records which will include psycho-social history.
• Presenting substance abuse and any mental health diagnosis'
• TB screening results (last 6 months)
• Must have or provide paperwork of Recent physical (last 30 days)
• Must furnish proof of participation in a licensed substance abuse program.
• Two weeks rent due at time of acceptance into program ($100.00 per week)
• All residents must be able to maintain employment and/or full time education.
• All residents must be willing to do volunteer work in the community.
• All residents must attend Church, Bible study, and any Church services provided by the Gateway.
• If you are prescribed medication, please come with a signed Dr.'s order and at least a thirty day supply of your meds & available refills.
Residential application
Gateway Freedom Center
1315 North Main Street, Salisbury, NC 28144
Office 704-638-2000 / Fax 704-310-5724
1. Applicant Information
Applicant Full Name:
Home Address:
City/State/ZIP:
Number of years at this address:
Daytime phone:
Evening Phone:
Mobile phone:
Social Security Number: *
*Social Security Number required for background check, and any other data requirements.
Driver’s License (State/Number):
Date of Birth:
Age:
Do you have children:
If yes how many:
What are their ages:
Do you have custody:
If you have custody, who will take care of your children while you are at GFC?
Are any other agencies involved in the care of your child/children? Yes/No
If yes, list agencies or people:
Do you receive any type of child support, food stamps, WIC, SSDI, etc? Yes/No
Do you have any physical disabilities? Yes/No
If yes, please explain
Do you have any pending charges/cases? Yes/No
If yes, please explain, list court dates:
2. Emergency Contact
Who should be contacted if you are involved in an emergency?
Contact Name:
Relationship to you:
Address:
City/State/ZIP:
Daytime phone:
Evening phone:
3. Who referred you to our Ministry?
Phone#:
Do you have any friends or relatives who live here? If yes, please list here:
4. Are you currently taking medications? If yes, please list here:
Medical Diagnosis:
5. Are Meds self-taken? Yes/No
or Medically Assisted? Yes/_No
6. Have you applied for residence to our Ministry previously? Yes/No
If yes, when?
7. Are you at least 18 years old? Yes/No
8. Are you presently employed? If yes, list employer
Do you have any additional incomes? Yes/No
If Yes, list income.
9. If you are offered residency will you be able to pay $50.00 weekly? Yes/No
10. If you are offered residency, date available for admission?
11. Have you ever been convicted of a felony or misdemeanor?
Yes, I was convicted of
on
(date) in
(city),
(state)
THE EXISTENCE OF A CRIMINAL RECORD DOES NOT AUTOMATICALLY PREVENT ACCEPTANCE.
12. Are you on probation?
If yes, who is your probation officer?
Address:
Phone #:
Fax#:
13. Applicant Transitional Residential History
List your current or most recent Transitional Address History. Please list all transitional homes in which you have lived, beginning with the most recent. If additional space is needed, continue on the back page of this application.
Prior Residence:
Supervisor Name:
Phone:
Address:
City/State/ZIP
Job Duties:
Reason for Leaving:
Dates of Residence (Month/Year):
Prior Residence:
Supervisor Name:
Phone:
Address:
City/State/ZIP
Job Duties:
Reason for Leaving:
Dates of Residence (Month/Year):
16. References
List any two non-relatives who would be willing to provide a reference for you.
Name:
Address:
City/State/ZIP:
Telephone:
Relationship:
Name:
Address:
City/State/ZIP:
Telephone:
Relationship:
17. Please provide any other information that you believe should be considered beneficial, in evaluating your application for residency:
Before you can be admitted to the Gateway Freedom Center, Inc., you must have the following:
________ N.C. Picture ID / Drivers License
________ Social Security Card
________ Proof of physical within last 30 days
________ Results of TB screening within last 6 months Date: __________
________ 30 day supply of prescriptions & refills on each
________ Signed doctor’s order to self-administer all prescription you are taking and for over the counter medications.
________ If you plan on keeping a vehicle for your personal use, you must bring driver’s license, proof of valid insurance, and current registration.
It is the policy of Gateway Freedom Center to provide equal residential opportunities to all applicants without regard to any legally protected status such as race, color, religion, national origin, age, disability or veteran status.
CERTIFICATION
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if residency commences, immediate eviction.
I authorize Gateway Freedom Center to contact former Residence(s) regarding my time there. I authorize my former supervisor(s) to fully and freely communicate information regarding my previous residency. I authorize those persons designated as references to fully and freely communicate information regarding my previous residency.
If a residential relationship is created, I understand that unless I am offered a specific written contract of residency signed on behalf of the organization by its Director, the residency relationship will be based on programs, and probation or “at will.” In other words, the relationship will be entirely voluntary in nature, and either I or the resident will be able to terminate the relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the residential relationship when I choose and for reasons of my choice. Similarly, the Director will have the same right. Moreover, no agent, representation, or employee of Gateway Freedom Center, except in a specific written contract of residency signed on behalf of the organization by its Director, has the power to alter or vary the voluntary nature of the residential relationship.
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDRESTAND AND AGREE TO ITS TERMS.
__________________________________ ______________________
APPLICANT SIGNATURE DATE
__________________________________ _______________________
DIRECTOR SIGNATURE DATE
* Your personal information will be kept confidential.
