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Admission Application


House of Hope exists to confront the issues of childhood sexual abuse and exploitation through awareness, training and treatment programs for girls and women.


All services are provided without regard for race, sex, creed, religion, or national origin.

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Please make sure to fill out and complete the Referral Form along with your application.

Applicants must complete all Intake Forms when applying to House of Hope Girls Program.

Case Manager

Youth History

Indicate any of the following that apply to the youth:



Education History

Health History

If youth has allergies, please provide a copy of this with the latest transcripts.

Additional Youth/Family Information

Four Things You Should Know:

A medical examination by a physician will be required as a part of the placement process. Financial arrangements will be discussed during the application process and finalized at the time of placement.


30 days of medication should be provided on the date of intake.


All youth are accepted on a 30-day assessment basis. Based on information gathered during this assessment House of Hope Clinical team will make an acceptance decision.


If emergency placements do not meet the criteria for sexual exploration, they will be given a discharge notification.

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