ARC Intake Questionnaire
Thank you for your interest in joining the Anti-Recidivism Coalition. ARC was founded to serve individuals coming home from DJJ and CDCR who want a community that supports their change and success. In order to best serve you, we ask that you complete this questionnaire to get to know a little bit about you. Space in our orientation is limited to 10 people per week. You will be contacted by an ARC staff to schedule your orientation time and date. Please note that we are not able to invite everyone to an orientation.
Email address *
Please type your first and last name. *
Your answer
Please enter your cell phone number. *
Your answer
What is your expressed gender? *
What is your age? *
Are you currently on parole or probation? *
Required
Were you incarcerated in California? *
Have you served a life sentence? *
Where did you serve your most recent sentence? *
What was your age of first involvement with the criminal justice system? *
How old were you at the time of the offense for which you were most recently incarcerated? *
Prior to incarceration, which of the following did you struggle with? (Check all that apply) *
Required
Which of the following are your currently struggling with? (Check all that apply) *
Required
How many times have you been incarcerated (jail or prison)? *
What is the longest amount of time you have served during a single sentence? *
What is your primary reason for joining the Anti-Recidivism Coalition? *
Your answer
How do you plan to contribute to the Anti-Recidivism Coalition and the larger community? *
Your answer
How did you hear about the Anti-Recidivism Coalition? *
Name of agency or person that referred you:
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service