Get Connected to Services

BEFORE COMPLETING THIS FORM, MAKE SURE YOU ARE ABLE TO OBTAIN YOUR BOARD OR COURT ORDERS AND SPEAK TO YOUR PROBATION, PRE-TRIAL OR PAROLE OFFICER ABOUT OBTAINING YOUR RISK SCORE***

 This form is for anyone who has been impacted by incarceration and desires assistance navigating resources.  Our Navigators have been formerly incarcerated and know your path. Get Connected guides individuals to opportunities like career & development, Education options & Training, Financial Workshops and Pro-social engaging.  

 After completing this form you will be contacted to begin developing a custom GOAL plan for your specific needs.  Email questions to: info@getconnected815.org or visit our website www.getconnected815.org or call the office at 779-513-2656.

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FIRST NAME *
LAST NAME  *
Phone number
Date of Birth *
MM
/
DD
/
YYYY
Email *
Complete Address (City, State, Zip Code)
Are you on Probation or Parole? *
Required
If on Probation or Parole -  provide your IDOC# or MID#
PAROLE AGENT/PROBATION OFFICER/PRE-TRIAL OFFICERS NAME? *
BOARD ORDERS / COURT ORDERS (Check ALL that APPLY) *
Required
What services do you need help with? *
Required
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