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Have you been Incarcerated? We'd like to learn from you...
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Your Name (optional)
Your answer
Approximately, how much time have you done (altogether)
Your answer
How long have you been out?
Your answer
What type of places have you been incarcerated in? (Check all that apply)
County Jail
State Prison
Federal Prison
Transition Center
Juvenile Detention
Other:
Things you could have used help with upon your release (check all that apply)
Transportation
Housing
Finding Work
Current World Events
Smart Phones
Computers
Shopping: Chip Cards, Self-Checkouts, Online checkouts
Social Interactions
Friendships that wouldn't take you down a wrong path
Interpersonal Relationships
Addiction Issues
Mental Health (depression, anxiety, panic attacks, bipolar, schizophrenia etc…)
Trauma/PTSD
Feeling Safe
Healthy Habits
Time Management
Money Management
Personal Identity Issues
Feeling Part of Society
Feeling Cared About
Other:
Which of these issues still need to be addressed in your life? (check all that apply)
Transportation
Housing
Finding Work
Current World Events
Smart Phones
Computers
Shopping: Chip Cards, Self-Checkouts, Online checkouts
Social Interactions
Friendships that wouldn't take you down a wrong path
Interpersonal Relationships
Addiction Issues
Mental Health (depression, anxiety, panic attacks, bipolar, schizophrenia etc…)
Trauma/PTSD
Feeling Safe
Healthy Habits
Time Management
Money Management
Personal Identity Issues
Feeling Part of Society
Feeling Cared About
Other:
Has there been anything that has really helped you that you would like to share?
Your answer
What would be your best advice to someone being released from incarceration?
Your answer
Please tell us anything about yourself or any ideas that you would like to offer that you think we should consider:
Your answer
Would you like us to contact you?
Yes
No
Maybe
Other:
Clear selection
If yes, what's the best way to contact you?
Call
Text
Email
Clear selection
If you'd like us to call or text you, whats the best time to do so?
Your answer
Your phone number and or email (Optional)
Your answer
Anything else you would like to tell us?
Your answer
I identify my gender as:
Female
Male
Prefer not to say
Other:
Clear selection
My present age group
under 18
19-29
30-39
40-49
50-59
60-69
70-79
80+
Clear selection
Submit
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