Start Here Build a Stronger Future APPLY TODAY! Start here to find the support you need. Fill out this form or call us at (313) 784-9209 to apply for help. We want to help you get on the right path. apply-now Are you completing this form for yourself or someone else?*MyselfSomeone ElsePlease enter your contact informationYour First Name* Your Last Name* Your Phone Number*Email Address Please enter the information for the potential participantFirst Name* Last Name* Date of Birth* DD slash MM slash YYYY Are you an ex-Felon?* Yes No Is this person currently incarcerated?* Yes No Please enter name of facility/prison Department of Corrections #Parole/probation officer name Parole/probation officer phone #Parole/probation officer address Have you been released more than 3 years? Yes No Were you convicted of a violent crime?* Yes No Were you convicted of a sexual crime?* Yes No Alternate Contact* Who is helping you once you get out of prison?Relationship*Parent/GuardianSpouseOther RelativeFriend/Friend-of-familyContact Number*In addition to job placement and training, what other services do you need?* Educational Referrals High School Diploma/GED Trade/Vocational Financial Aid Assistance Clothing for Job Search Transportation Stable Housing Substance Abuse Treatment Documentation (ID, SS#, etc.) Choose all that applyPlease list any other issue that may affect or have affected your ability to get and maintain employment. Also use this area to provide any additional information you would like us to know (not required).
