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Returning Citizen Registration

* required fields

Last Name *

First Name *

Middle Initial

Preferred Name (Required)

Gender *

Date of Birth *

User name (you can use your Prison Id #. Minimum of 4 characters. No blank spaces, please.) *

Prison ID # (If none, list your county of incarceration and jail ID #)*
If you are not currently incarcerated, please enter the number “0”.

Password (4 characters min) *

Confirm Password *

Email for when you are on the outside

Please select the state you are incarcerated in. *

(Or "Federal" if a federal prison)

Release Address If unknown, list your best guess of the zip code where you will be released

Street Address

City *

State *

Zip

List any reliable phone number(s) where you can be reached on outside, if any (maximum 3)

Projected Release Date* (If not currently incarcerated, enter today's date)

Will you be under community supervision(parole/probation) upon release? *

These questions are optional. Some services and programs may not be available for those with a conviction for a violent or sexual crime. In order to better match you with appropriate service providers and save you frustration, please indicate your answers to the following.

Have you ever been convicted of a violent offense?

Have you ever been convicted of a sexual offense?

Education Check highest grade available

Elementary
Some High School
Graduated High School
GED
Some College
College Degree

What services are you interested in upon release? Select all that apply

Shelters & Housing
Support Groups (peer, family, etc.)
Multiservice Agencies (counseling, food, clothing, etc)
Churches and Ministries
Substance Abuse Treatment & Recovery
Health Care
Legal Matters
Employment and Job Training
Education

Is there anything that you’d like service providers to know about you?

STAFF USE ONLY (Not visible to public. Only visible to ION staff.)

I agree to share my profile information with service providers in my area. *

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