| |
* Required information |
| First Name: |
* |
| Last Name: |
* |
| Address 1: |
|
| Address 2: |
|
| City: |
State: |
| Zip/Postal Code: |
* |
| Phone Number: |
|
| Fax number: |
|
| Other (pager, mobile, etc.) |
|
| E-mail address: |
* |
| |
|
| Did this story occur in Texas? |
* |
| Is this your story or the story of a friend or
family member? |
* |
| What is the individual's name? |
* |
| What is the individual's date of birth? |
* |
| Was the individual incarcerated? |
* |
| Was the individual put on probation? |
* |
| If sentenced, what was the sentence for and how
long was the sentence? |
|
| If sentenced, when did the sentence begin? |
|
| If sentenced, has the sentence ended? |
|
| If incarcerated, where was the individual incarcerated? |
|
| What was the individual's day job before the
arrest, if any? |
|
| What was the individual's day job before the
arrest, if any? |
|
| How long had the individual had the job, if any? |
|
| What were the individual's goals in life or hopes
for the future before the arrest? |
|
| Did the individual have any significant accomplishments? |
|
| What community activities were the individual
involved with (i.e. church, school)? |
|
| Does the individual have a spouse, children,
or other dependents? |
|
| If children or dependents, where are they and
how has this affected them? |
|
| If a spouse, where is he/she and how has this
affected him/her? |
|
| If the individual has been released, what has
the re-entry process been like? |
|
| If the individual has been released, is he/she
employed? |
|
| If the individual has been released, does he/she
have housing? |
|
| How has re-entry affected the family? |
|
| Any other impacts on the individual or his/her
family? |
|
| |
|