Application & Intake Portal 🔒 100% Confidential

Begin Your Clean Pathways Journey

Taking the first step takes immense courage. Please select your application type below to initiate your confidential intake, mentorship placement, and housing onboarding.

Complete Form Below ↓

Step 1 of 2

Choose Your Application Category

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Student Applicant

Men seeking residence, recovery & biblical discipleship.

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Volunteer / Mentor

Offer classes, tutoring, life skills, or service hours.

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Prospective Staff

Apply for case management or facility positions.

Men's Residential Discipleship Application

All information provided is treated with strict confidentiality in accordance with HIPAA standards.

Full Legal Name *

Date of Birth *

Phone Number *

Email Address *

Current Living / Housing Situation *

Sobriety Status / Days Clean *

Do you have a High School Diploma or GED? *

Yes, I have a diploma or GED No (Need Adult Ed assistance)

Current Employment Status *

Briefly explain why you desire to join Clean Pathways *

I certify that all information submitted is true and accurate. I understand that Clean Pathways is a drug-free, faith-based discipleship program requiring accountability, curfew compliance, and community participation.

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Begin Your Clean Pathways Journey

Choose Your Application Category

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Men's Residential Discipleship Application

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