Christian Brother Application Form

Christian Brother Application

Newpoint Partnership Reentry Program

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Welcome! We are thankful that you have chosen to apply to the Newpoint Partnership Reentry Program.

This application is lengthy. Please be thorough and clear in your responses. If a question has multiple parts, be sure to answer all parts. Do your best so that we may understand you as well as possible and thus be able to serve you in the way most beneficial to you.

This application is encrypted in its transmission over the internet, so your data cannot be accessed by others.

It is simpler to complete this application in one sitting. However, you may save a partially completed application and come back to it at a later time to complete and submit. The save function is at the bottom of the main application. If you save the document, you will be sent an email with a link that will bring you back to your application. If you delete the email with the link, you will have to start a new application from the beginning. If you share your computer/tablet with others, ensure you logoff to prevent access to your application by others. Logoff either from the pop-up after you "Save" your application, or from the round, orange icon at the very top right of the application.

We at Newpoint Partnership look forward to receiving your application!

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Full Name *

First and Middle Names Last Name
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Date of Birth *

Month Day Year

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Social Security Number *
format: 999-99-9999 Minified React error #152; visit https://reactjs.org/docs/error-decoder.html?invariant=152&args[]=_Widget for the full message or use the non-minified dev environment for full errors and additional helpful warnings.
Enter your email, then click the Verify Email button.

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GDC Number *
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Primary crime for this incarceration *
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Date Present Sentence Began *

Month Day Year

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Length of Present Sentence (years) *
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Maximum Possible Release Date *

Month Day Year

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Tentative Parole Month/Year
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Maximum Parole End Date

Month Day Year

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Current prison *
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Enter your current mailing address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

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Enter your last residence prior to incarceration *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

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Who were you living with at the time of your arrest, what was your relationship to that person(s), and have you remained in contact with that person(s)? *
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Deputy Warden of Care & Treatment's Information *

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Counselor's Information *

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Chaplain's Information

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Which of the above 3 persons knows you the best? *

Deputy Warden of Care & Treatment Counselor Chaplain
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How would you rate your English reading and writing skills? *

Excellent Good Fair Poor
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Have you ever been convicted of being a sex offender? *

No
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Have you ever been convicted of arson? *

No
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The following documents are on the additional tabs/pages at the top of this form and are also available on the Newpoint Partnership website, http://newpointpartnership.org . Place a check next to each document you have read and agree to. *

Statement of Faith / Doctrinal Beliefs Christian Brother Rights Christian Brother Program Rules Christian Brother Graduation Requirements Christian Brother Discipleship Covenant Fee Schedule Financial Account Agreement CSO Communications Discipline Policy Pass Policy
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List every hold on you from other jurisdictions, whether local, county, state, federal, in or out of Georgia? This may include police, sheriff, courts, parole officers, or probation officers. State if the hold requires you to report somewhere else following your present incarceration. If none, enter "None". *
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List ALL previous incarcerations. If none, enter "None" under "Offense". Click "Save" for each row where data is entered. *

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Educational background. Click "Save" for each row where data is entered. *

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Work History. Include DOC positions. List most recent work first.

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Have you ever had a drivers license? If "Yes", what state issued it and was it ever revoked? *
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Enter any communicable disease (HIV, TB, Hepatitis B, etc.) you have. If none, enter 'None'. *
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List every medication/dose you are currently prescribed and the cause for the medication. If none, enter 'None". *
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List all allergies you have. If none, enter "None". *
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What is your marital status? *

Single Legally Married Common Law Marriage Widowed Separated Divorced
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If married, 1) when were you married, 2) when was your last contact with your spouse, and 3) what is your spouse's full name, address, phone, and email?
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If you are divorced or going through a divorce, what was the cause of the break-up?
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If you are currently in a romantic relationship (emotionally), please describe it. If not, enter "None". *
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List your children. For "Current Relationship" use code: N=None; L=Limited; S=Strong. If no children, enter "None" for Full Name. Click "Save" for each row where data is entered.

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Your Christian Walk:

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1. Give your personal testimony: a detailed story of how Jesus found you, what that encounter was, and what your life with Jesus is like now. Be personal, practical and real, not theoretical. Give examples. *
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2. Describe any biblical studies or correspondence courses you have pursued. *
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3. How are you serving Christ now? *
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4. How are you serving others now? *
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5. Have you served as a Chaplain's aide? Why or why not? *
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6. Describe a recent time when scripture or a Biblical teaching convicted your heart. *
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7. What character issues/unwise choices/addictions led you to your position in prison? *
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8. What are your short-term (less than a year) goals? *
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9. What are your long-term (5-10 year) goals? *
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10. Describe the kind of person you hope to be at the end of your stay at Newpoint House. *
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11. Are you certain that God exists? Explain your answer. *
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12. What does 'faith' mean to you personally? *
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13. Have you read through every book in the Bible? *

Yes No
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14. What change(s) have you experienced in your life since you started your relationship with Jesus? *
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15. Of all the teachings of Jesus Christ, what has come to be the most significant in your life? *
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16. In what way does your relationship with God make your way of facing life different than it was before you had this relationship? *
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Your Personal Situation:

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17. Describe your current relationship with your children.
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18. List ALL unpaid debts. Include alimony, child support, loans, traffic fines, inmate educational expense, court-ordered restitution payable to probation/parole departments or other agencies, etc. If none, enter 'None' for Debt owed to. Click "Save" for each row where data is entered. *

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19. Describe your history of tobacco use. *
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20. When did you last use tobacco? *
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21. Describe your history of drug use. List every drug you have used. What was your drug of choice? *
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22. When did you last use drugs? *
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23. Describe your history of alcohol use *
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24. When did you last use alcohol? *
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25. Is your present or any past incarceration drug or alcohol related? *

Yes No
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26. Have you ever participated in any drug or alcohol treatment program on an inpatient or outpatient basis? If "Yes", when was it, was it court mandated, and did you satisfactorily complete all of the treatment program requirements? Explain. *
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27. Identify ALL support programs (such as "12-step") offered at your current institution. Which of these have you participated in during your current incarceration? *
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28. Have you had any positive drug or alcohol screens during your present incarceration? If so, when? *
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29. Have you or a blood relative ever had a severe emotional problem? Explain. *
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30. Have you every been diagnosed with a mental illness? If "yes", what was the diagnosis, what treatment did you receive, and when was the treatment terminated. If no, enter "No". *
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31. Have you ever had any psychotherapy or counseling in or out of prison? If yes, when and where were you treated? Name the medications prescribed to you. What was the outcome? What is your current status in this regard? If no, enter "No". *
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32. Have you ever suffered from depression or anxiety? If "Yes", have you ever been treated for it and how does it affect you now? If "No", enter "No". *
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33. Have you ever thought about suicide? If yes, include when and how often you have had these thoughts. *
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34. Have you ever attempted suicide? If yes, include what method you used, when, and what your reason was. If no, enter 'No'. *
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35. Do you have any problems sleeping? On average, how many hours do you sleep each day? *
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36. How do you deal with your anger? Explain. *
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37. What self-help courses have you taken or self-help programs have you participated in while in prison? If none, enter 'None'. *
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38. What job training courses have you taken in prison? If none, enter 'None'. *
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39. What formal education courses (G.E.D., college courses, etc.) have you taken while in prison? If none, enter 'None'. *
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40. Check all the practices with which you have been involved.

Ouija board Palm reading Séances Horoscopes Satan worship Fortune telling Witchcraft Divining Spell casting Occult based games Hypnotism Voodoo Tarot cards Other occult practices
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41. Do you have any major tattoos? If "Yes", describe and explain. If no, enter "No". *
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42. Describe any gang affiliation you have had in the past 5 years. Note any rank held and length of affiliation. If none, enter "None". *
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43. What has been your history regarding pornography? When was the last time you viewed pornography? *
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44. Have you ever willingly had a homosexual encounter? If the answer is "Yes", how many times have you done so and when was the most recent time? If "No", enter "No". *
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45. Do you have any interest in homosexuality now? If "yes", to what extent? *
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46. What would you describe as your weakest character trait and why? *
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47. What would you describe as your strongest character trait and why? *
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48. List every Disciplinary Report you have had in the past 3 years, when you received it and why you received it. If you have had none, answer "No DRs received in the past 3 years." *
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Your Future and Newpoint:

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49. Do you have transitional housing opportunities other than Newpoint? If "Yes", list them. If "No", enter "No". *
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50. Give the reason(s) why you want to come to Newpoint. *
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51. How do you see yourself fitting in with the program of Newpoint Partnership as described in the Discipleship Covenant? *
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52. Which of the items listed in the Newpoint Rules will be most challenging for you to comply with and why? *
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53. Do you believe God is calling you to some specific ministry? If "Yes", what is it and why do you believe he is calling you to it? If "No", enter "No". *
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54. What are your goals for yourself while at Newpoint House? *
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55. What questions do you have concerning the Newpoint Partnership Reentry Program? *
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56. Having a humble and teachable spirit is absolutely necessary to succeed in and graduate from the Newpoint Reentry Program. Are you confident you are capable of this level of spiritual maturity? Explain. *
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57. Is someone in your support group able to pay the $150 admittance fee and the $190 weekly fee if you are admitted to the Newpoint Partnership Program? If yes, who is that person (provide name and full contact info). *
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58. Is someone in your support group able to provide clothes, personal items, etc.? If yes, who is that person (provide name and full contact info). *
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59. Who is your closest personal contact outside of prison? What is your relationship to him/her? What is his/her email address & phone number? *
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60. Would you expect to visit or be visited by the person listed above while you are at Newpoint House? *
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If possible, please provide 3 references, preferably persons not related to you and not presently incarcerated.

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I hereby certify that the information provided on this application is true and accurate to the best of my ability; that it is provided in confidence and that it will be used, in part, to determine my potential for admission to the Newpoint Partnership Reentry Program.

I understand that this application is not a guarantee of my admission. If accepted into the program, I agree to abide by the rules, policies and decisions of Newpoint Partnership and to submit to those in authority in that ministry.

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Today's Date *

Month Day Year

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Signature *

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Please Run the Wizard
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Should be Empty: