Reclaiming Innocence Project Application - Cohort III

Participant Information

Residency Status
What Is Your Gender Identity? *
What Is Your Sexual Orientation? *
Race *
Do You Have Any Of The Following Identifying Documents (Check All That Apply): *
What are your greatest concerns and needs at this time (check all that apply) *

Education and Financial Resources

Are You Currently A Student? *
What Is Your Income Source? *
Do You Have Proof Of Income/Verification Of Benefits? *

Housing History

Do You Currently Pay Rent? *
Have You Ever Been Evicted? *
Have You Ever Lived In A Transitional Living Facility Before? *

Justice Involvement (Legal History)

Have You Ever Been Convicted And Served Time In A California State Prison? *
If Yes, How Long Ago Were You Released From CA State Prison? *
Are You Currently On Parole? *
Are You Currently On Probation? *

Mental Health Wellness

Have You Ever Used Substances (alcohol or drugs)? *
Do You Currently Use Substances (alcohol or drugs)? *
Are You Currently Engaged or Interested In Recovery Support Services? *
Are You Currently Engaged In Any Outpatient Or Mental Health Services? *
Are You Interested In Engaging In Any Outpatient Or Mental Health Services? *
Have You Ever Received A Mental Health Diagnoses? *

Reference of Support

Do You Currently Have A Case Manager or Support Reference? *
Specify How You Were Referred To The Program? *

Emergency Contact

Acknowledgement Clause

BY CLICKING, I affirm, I have had justice involvement with California State Prisons. I hereby acknowledge that I have completely read, understand, and certify that all the information and answers to questions are complete, true, and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts in the Reclaiming Innocence application may disqualify me from continuing to participate in the AMAAD Departmental Programs and render this application void. *