Program Assessment

“You Are Not Your Past!”

This short questionnaire helps us understand your current situation and goals so we can determine the best fit and starting point for you in the RESET Program.

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Tell Us About Yourself

Your answers are used only to evaluate your fit for the program and plan your individualized support. There is no cost or obligation to complete this form.

Full Name

Email Address

Phone Number

Which RESET Program Are You Signing Up For?

How did you hear about RESET?

Current Housing Status

Current Employment Status

When did you last leave incarceration (or when is your release expected)?

What are you hoping to achieve through RESET?

What challenges are you currently facing that you'd like support with?

What is your availability to participate in an 8-week program?

Anything else you'd like us to know?