Apply for Destiny House Name * : Last Name * : Birthday: 00/00/00 * : Number You Can Be Reached At * : Email Address * : Are you still involved in prostitution? * : YesNo What age did you become involved in prostitution? * : How long have you been involved in prostitution? * : What is your current living situation? * : Do you currently have a pimp? * : YesNo Do you currently have children living with you? * : YesNo If yes, how many and what are their ages? Are you currently addicted to drugs or alcohol? * : DrugsAlcoholBoth Drugs and AlcoholNone of the above Have you been through a drug or alcohol program? * : YesNo Are you willing to commit to a program to get help? * : YesNo How did you hear about us? * : TV ShowFriendWebsiteHookers for JesusOther Anything else you would like us to know?