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 *
Please type your first and last name. *
Please enter your cell phone number. *
What is your expressed gender? *
What is your age? *
Please select which option best describes your current living situation. *
Please select which option best describes your current employment status. *
Please select which option describes your current education status.
Clear selection
What is your highest level of education? *
Are you currently on parole or probation? *
Were you incarcerated in California? *
Have you served a long-term or 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) *
Which of the following are your currently struggling with? (Check all that apply) *
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? *
How do you plan to contribute to the Anti-Recidivism Coalition and the larger community? *
How did you hear about the Anti-Recidivism Coalition? *
Name of agency or person that referred you:
A copy of your responses will be emailed to the address you provided.
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