Application

Email: [email protected]

Phone: (833) 505-4712

Address:
Reentry Support House LLC
691 John Wesley Dobbs Ave. NE
Suite C – V-384
Atlanta​, GA​ 30312​

Application for Qualification

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Full Name *

First

Last

Full GDC#

Email

Email

Confirm Email

Contact Phone Number *

Age

Currently age 18

Birthdate *

Name, Number, and Email address of the person Financially responsible for enrolling you into the program?

Are you currently Incarcerated, at Halfway House or at a Transitional Center? *

• Incarcerated
• Halfway House
• Transitional Center

Are you Born in the state of Georgia *

• YES
• NO

Do you have a Certified Copy of your Birth Certificate? *

• YES
• NO

Do you have a State Issued Identification Card? *

• YES
• NO

Do you have your Social Security Card? *

• YES
• NO

In what County did your Convictions take place? *

What is your Max Out Date? (if applicable)

Are you a Registered Sex Offender? *

• YES
• NO

Will you be on or are you currently on Probation or Parole? *

• Federal (Probation or Parole)
• State Probation
• State Parole
• No (Probation or Parole)

Have you currently or in your past been diagnosed with any Mental Health Condition? *

• YES
• NO

Have you ever had any Drug or Alcohol addictions? *

• YES
• NO

Will you have any issues sharing a room with someone that is Transgender or Gay? *

• YES
• NO

Do you have any physical condition that will prevent you from working a Full-Time Job that will require standing on your feet for 8 hours or lifting up to 50 lbs on a continuous basis? *

• YES
• NO

Will you have any issues walking up to 2 miles to get to the nearest public transportation? *

• YES
• NO

Please list any special skills or certifications you may have held in the past. *

What is your short-term goals within the first year of your release?

Name 3 reasons why you feel you should be accepted into Reentry Support House LLC housing program?

Submit