Apply for Lydia’s Home Residency
Our 3-Part Application
YOU MUST SUBMIT ALL 3 PARTS OF THE COMPLETED APPLICATION TO BE CONSIDERED. If you have questions during the application process, contact your Case Manager. If you don’t have a Case Manager, contact us.
Part 1: General & Legal Information
Part 2: Health History & Emergency Contact
Part 3: Employment & Background Information
SCROLL DOWN TO APPLY ONLINE OR DOWNLOAD THE APPLICATION
Part 1: General & Legal Information
Click the button to complete Part 1 of the application online.
Or, use the options below to download Part 1 and upload the completed document.
Online Application Form - Part 1
OR
Download Part 1 of the Application to Complete on Your Computer
Then, Upload the Completed Part 1 by Clicking the Button
Part 2: Health History
Tell us about your health history and provide us with an emergency contact person for your stay. Click the button to complete the online application, or use the options below to download Part 2 and upload the completed document.
Online Application Form - Part 2
OR
Download Part 2 of the Application to Complete on Your Computer
Then, Upload Completed Part 2 by Clicking the Button
Part 3: Employment history
Tell us about your recent employment history, including your current job and up to three recent jobs. Click the button to complete the online application, or use the options below to download Part 3 and upload the completed document.
Online Application Form - Part 3
OR
Download Part 3 of the Application to Complete on Your Computer
Then, Upload Completed Part 3 by Clicking the Button
See Inside Lydia’s Home
Download the Program Overview
Thank You for Your Interest in Lydia’s Home
Contact Tamela Shawhan, Director of Operations at 330-807-8226 or email tamela@brokenchainsministry.org with any questions you may have.
Our Director
Tamela Shawhan, Director of Operations
“When she and the members of her household were baptized, she invited us to her home. “If you consider me a believer in the Lord,” she said, “come and stay at my house.” And she persuaded us.”