Circle's Program Application
Fill out this form to apply to be a Circles Leader.  
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First Name *
Last Name *
Phone Number *
Email *
Address *
Birthday *
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Are you employed? *
If so, what is your place of employment?
Do you have children? *
If so, please list their names and ages.
Are you receiving any government benefits? (food stamps, housing, etc.) *
Did you graduate high school or do you have a GED? *
Do you have a college education? *
If so, to what degree or level of completion?
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Would you be able to attend weekly meetings on Tuesdays from 6 to 7:30? *
Have you been in recovery for at least the past 6 months if history of alcohol or other addiction? *
If you feel comfortable, talk about some of your goals and what you want to get out of the program.
Do you live at or below 185% of the Federal Poverty Guidelines?
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How did you hear about Circles?
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