Skip to main content
@media (min-width: 700px){ }
Toggle navigation
Home
Real Men Talk
Calendar
Calendar
Events
Men Mentor
Men's Health
Program
Program
Restoring Men
Youth Program
Job Interview
Job Training Course
Workshop Training
Services
Services
Family Law Legal
Digitial Navigator
Intake Form
Partnership
Partnership
Dr.Coles Ministry
Jobs For Life
Dr Calvin Ellison
William's Marketing
KOP Mentoring Network
CFADD
Biblical Talk
Magazine
Charles L. Franklin Associates
News & Events
PLEASE FILL OUT THE INTAKE FORM
Date
First name
Last name
Date Of Birth
Gender
City
State
Home Number
Cellphone
Email
Name of Insurance Company
Insurance ID
T-Shirt Size
L
XL
XXL
3XL
Do Want a Men Mentor
No
Yes
What Services You Need Help With
Job
Health
Housing
Training
Budget
Reentry Program
Legal
Computer and Tablet
Voter Registration
Food
Child Support
If You Release From Prison Fill Out This form below
Date of Release
How long you have been lock Up
Type of Crime
Are You a Sex Offender
Do You Have Family Support
Are you a Christian? .
NO
YES
Do you have a Church Home
Comments
Do not enter anything in this field: