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Boys' Haven of America Foundation

Contact Us:

Jim Ferrel Jr.
Development & Business Manager

Boys’ Haven of America, Inc.
P.O. Box 5815
Beaumont, TX 77726

3655 N. Major Dr.
Beaumont, TX 77713

Ph: 409-866-2400
Fax: (409)-866-7610



Admittance Requirements and Application Procedure:

Sufficient factual information must be disclosed to the Casework Manager to accurately evaluate the child's needs and the ability of this facility to meet those needs.
Boys' Haven is a basic care residential facility, equipped to serve children who meet the following criteria.

In order to qualify for admittance into Boys' Haven, the child must:

1. Be at least 8 years of age, and no older than 17 years of age;
2. Be able to physically participate in a very demanding and active program;
3. Be free from contagious or infectious disease, and cannot require a special diet;
4. Not be physically or emotionally dependent on drugs or alcohol;
5. Be able to attend and be enrolled in public school;
6. Not be severely mentally impaired;
7. Not be an endangerment to himself or others (i.e. he cannot be suicidal, homicidal, set fires, hurt animals);
8. Be able to function in an environment where compliance to the rules is mandatory without the use of physical force;
9. Be able to receive support in developing and maintaining social skills appropriate to his age and development;
10. Be able to participate in age and developmentally appropriate activities to promote his well being;
11. Not be significantly organically impaired;
12. Meet Level 1, 2, or 3 criteria of care.
The individual seeking placement for the child must have legal guardianship or authority of him. Documentation of custody is required prior to placement.
The party first in legal authority over the child shall, by notarized contract, place the child in the care, custody, and control of Boys' Haven for a minimum of one year. This contract does not terminate the legal guardianship of the party.
The application must be filled out completely and to the best of your knowledge. Once the application has been received, allow one week for the review process to take place.
Availability of placement is not guaranteed when an application is received.
If all available room is currently taken, your child will be placed on a waiting list, based on his need for care. The waiting list is not based on a first come, first serve basis. Each application is reviewed carefully and placement is determined by which applicant needs the most immediate care.
Once the application has been reviewed and it is determined that the child meets placement criteria, he will be called in for a pre-placement visit which consists of a 3 day visit during which the child will stay at Boys' Haven. During this time, he will be evaluated by staff to determine placement eligibility. The cost of the pre-placement visit is based on a sliding fee scale determined by the information on your pay stubs and tax return. The child must bring proof of a recent TB skin test to the pre-placement meeting.
Once the pre-placement visit concludes, a Boys' Haven representative will contact the guardian to discuss enrollment eligibility. If it is determined that the child should return to placement, and both parties are in agreement, a date for placement will be set as soon as possible. Prior to returning for placement the child must receive an updated physical and dental exam and receive any necessary immunizations.
The guardian and a Boys' Haven representative will discuss the amount to be paid for Program Service Fees monthly and the method of payment prior to placement. This amount will be recorded on a notarized form on which the legal guardian will sign verifying the amount and method of payment at the time of placement. Program Service Fees are based on a sliding fee scale.
All information obtained from the application and additional paperwork is confidential and will only be reviewed by Boys' Haven staff. The legal guardian reserves the right to withdraw the child's application at any time.

Application For Admission Form

E-mail Address: *
Childs Full Name
Date of Birth
Place of Birth
Grade
Age
Race
Hair Color
Eye Color
Height
Weight
Social Security No.
Country
Primary Language
Religious Preference
Current Location of Child
Legal Guardian
Your Relationship to the child
Please list all contact numbers
Address
Please list all allergies, disabilities, diseases or medications
Reason Seeking Placement
Has child been placed away from home before? If yes, explain
What goals do you want your child to achieve through placement?
Describe childs behaviors including both appropriate and inappropriate behaviors
Does child have a history of substance abuse? If yes, explain
Does child have a history of being abused? (Physical, sexual, emotion, or neglect)
Does child have a history of abusive behaviors? If yes, explain
Does child have a history of involvement with the Juvenile Justice System? If yes, explain
Describe childs strengths (socailly, behaviroal, athletically, musically, etc.) Does child have a special talent of gift? Has child received special recognition in school or other areas?
Has child demonstrated any interest in violent popular culture? (I.e. horror movies, books, music with graphically violent or occult themes)
Does child identify with any partcular social sub-group (skater, punk, metal head, prep, gangs, etc?)
Talks about killing self
Earnestly attempted suicide
Damages or destorys own property
Damages or destroys property of others
Vandalizes
Set Fires
Runs away from home
Steals at home
Wets self during the day
Wets the bed
Has bowel movements outside the toilet
Does not appear to feel guilty after misbehaving
Lies and/ or cheats
Withdrawn, does not get involved with other children
Prefers playing with older children
Has trouble sleeping
Demands attention
Gets into fights
Associates with children who get into trouble
Swears, uses obscene language
Has temper tantrums, is volatile
Impulsive, acts without thinking
Describe childs adjustment in school. Has child ever been in In-School Suspension, SAC, expelled, or attended behavioral modification classes? If yes, explain:
Please list last grade completed. Does child have a history of truancy? Has child ever repeated a grade level?
Describe any problems that child has in school. (relating to teachers or school personnel, concentration, organizational skills, turning in homework, etc.)
Discuss childs current educational level. (Resource classes, grades, conduct, etc.)
Did child have any difficulties in achieving develpmental milestones such as learning to walk, talk or function properly? If yes, explain:
Briefly describe childs current level of functioning:
Describe childs past and current medical history. Has your child been on any long-term prescribed medications?
Is child accident prone or has child suffered any injuries to the head. (Fallen, knocked-out, car accidents, etc.)?
List the childs previous experiences with psychiatric counseling, evaluation, or hospitlizations. Did he benefit from it?
Does child have any special needs or require any special care?
Does child wear glasses, contact lens, hearing aid, braces, retainers or any other devices that will need a doctors services?
List all persons living with the child at this time, relationship and age:
Is child adopted? If yes, at what age? Does child know the biological parents?
Have the parents been separated or divorced during the childs life? How old was the child at the time?
Briefly describe childs living environlment for the first three years of life. (Stable, loving, chaotic, violent, etc):
Briefly describe childs relationship with family members:
Briefly describe childs relationship with other adults (grandparents, aunts, uncles, etc.)
Has there been a death of anyone close to the child, such as a father, mother, brother, sister, grandparent, friend? What was the cause of death?
Do any family members have emotional, physical or learning problems? If yes, explain:
Have there been any other significant incidents in the childs life that were difficult for the child and would help us understand the childs problems?
SuicideNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Violent towards familyNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Drug AbuseNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Alcohol AbuseNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Sexual AbuseNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Sexual MisconductNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Psychiatric ProblemsNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Chronic PovertyNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Criminal BehaviorNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Jail or PrisonNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Discipline Skills LackingNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
IsolationNatural Father
Natural Mother
Siblings
Step-Father
Step-Mother
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother
Please list all monthly incomes including Net Salary, Second Net Salary, Child support, S.S Benefits, Disability and any other form of income
Please list all monthly debts including Rent/House Payment, Monthly Utilities, Child Support, Credit Cards, etc.
Name of person completing application and relationship to child:

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