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Reconnect with Tech Registration
This program is for justice impacted individuals (formerly incarcerated). Please tell us about your computer / internet needs and experience.
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* Indicates required question
Are you a formerly incarcerated/ justice involved individual?
*
Yes, I have been incarcerated in the past.
No, I have never been incarcerated or in jail.
First Name
*
Your answer
Last Name
*
Your answer
What is your birthdate?
*
MM
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DD
/
YYYY
Phone Number
*
Your answer
Street address
Your answer
Zip code
*
Your answer
E-Mail
Your answer
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