Pre-Release Enrollment Form 2024

Pre-release is the process that happens prior to a client’s release from incarceration. Pre-release consists of connecting with currently incarcerated clients looking to receive support, and if requested, speaking on behalf of the client to the parole board to advocate for their release.  Upon release, we connect clients with our pre release case manager, Smitty, to create a reentry plan together and ensure clients are connected with our services upon their return.

Have someone returning home from incarceration soon? Want to refer them to our services? Fill out the form below and we will be in touch!
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Email *
Client's Government Name (and preferred name if different) *
Client Date of Birth
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DD
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DOC # *
Facility Incarcerated At *
Referred By *
Referral Name/Contact (phone, email) *
Parole Hearing Date  (Unfortunately, we CANNOT help until the client has a set hearing date. Please provide clarification if needed)
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/
DD
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YYYY
Client Charge(s) and Time Served *
Any other contact persons you believe we should contact on behalf of the client? (if so, please provide contact info if known)
Do you know if the client will need transitional housing upon their release?
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Anything else we should know?
Submit
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