Application for Acceptance to Hannah House

This information is confidential. The information in this application will not be held against you or used to judge you in any way. Hannah House is dedicated to helping those who need emotional and spiritual healing and restoration. If for any reason Hannah House cannot meet your particular need, we may be able to refer you to someone who can. Please answer all questions honestly so we may know the best way to help you. Please do not leave any blanks in your application as this will delay processing. If a question is not applicable to you please put NONE or N/A.

Parent or Guardian

Physical Characteristics:

Phone: 479-782-5683
Fax: 479-782-5554
E-Mail: [email protected]