Circle Ally Application
Name *
Address *
Phone Number *
E-Mail *
Date of Birth *
Spouse Name
Spouse Phone Number
Spouse E-Mail
Spouse Date of Birth
Highest Level of Education *
Current Employment *
How did you hear about Circles? *
Why are you interested in being a Circle Ally *
Check the boxes below to indicate if you would have a problem working with an individual who is or has: *
Required
If yes to any of the above, please explain:
Would you be willing to provide transportation to your Circle Leader if necessary? *
Skills: Please check all that apply *
Required
If other skills, please list
Have you ever been convicted of a felony? *
Do you currently have any pending court cases? *
If yes to either of the above, please explain.
Please check each box to indicate you understand and agree *
Required
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