Self Referral Form - Goodwill Re-entry Navigation

Thank you for your interest in the Goodwill Re-entry Navigator Program. This program is FREE for individuals who meet the following criteria:

  • Must have criminal justice involvement; 
  • Must reside in Winnebago County; 
  • Must be 18 years of age or older. 
The Navigator program provides one-on-one support for individuals who struggle with barriers during their reentry experience.

Please complete this form and one of our navigators will contact you to schedule an intake meeting. 

Sign in to Google to save your progress. Learn more
Your name  *
Your email address  *
Your contact phone number  *
Your preferred method of communication  *
Your IDOC#/MID# (if you know it)  *
Have you  had a Risk and needs assessment done recently? If yes, do you know your score? 

(If no, that is okay. We can help you do this assessment later.)
*
Do you have any of the following court Orders/Parole Board Orders? Check all that apply.  *
Required
Are you currently referred to IDOC Day Reporting Center (DRC) for services?  *
Required
Have you been referred to Winnebago County Resource Intervention Center (RIC) for Services?  *
Please check the areas you would like assistance in. (Click all that apply) *
Required
Please share any comments or notes.  *
Thank you for sharing this information. We will contact you with any questions and will reach out to the participant within 2 business days. 
If you have questions, please contact us at Programs@goodwillni.org or 815-965-3795.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report