Application for HFAF, LLC

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Questionnaire

Email *

Your Full Name and GDC# (if applicable) *

Are you currently incarcerated or at Halfway House? *

Yes

Will you be on or currently on Probation or Parole? *

Federal (Probation or Parole)

State (Probation or Parole)

NO (Probation or Parole)

Contact Phone Number *

What is your Max Out Date (if applicable)

Are you a Registered Sex Offender? *

Yes

Do you have your Social Security Card? *

Yes

Do you have a Certified Copy of your Birth Certificate? *

Yes

Have you currently or in your past been diagnosed with any Mental Health Condition? *

Yes

Have you ever had any Drug or Alcohol addictions? *

Yes

Do you have any physical condition that will prevent you from working a Full-Time Job that will require standing on your feet for 8 hours or lifting up to 50lbs on a continuous basis? *

Yes

Will you have any issues sharing a room with someone that is Transgender or Gay? *

Yes

Will you have any issues walking up to 2 miles to get to the nearest public transportation? *

Yes

Please list any special skills or certifications you may have held in the past. *

What is your short-term goals within the first year of your release? *

Name 3 reasons why you feel you should be accepted into Housing For All Felons LLC housing program? *

What is the Name, Number, and Email address of the person Financially responsible for payment? (if applicable)

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