Project New Start interest form

Program Description:

Project New Start is a job placement program offering mental health and legal services for those who have experienced incarceration. Our team works together to develop an individualized plan that meets the needs of each participant in overcoming barriers to employment. Eligibility for this program is that you must be 18+ years or older, and have had an impactful interaction with law enforcement or the justice system (even for one day).

Services include individualized support from a peer support specialist, a social worker, and an occupational therapist; legal aid assistance; involvement in work readiness workshops; support in vocational exploration; and encouragement of community.

Training options include:

Industrial arts studio-based training that explores and expands marketable creative talents.
Technology and Social media developing skills in using technology and social media to tell stories and engage followers
Peer work an introductory overview of what is involved in becoming a State Certified Peer Specialist using lived experience and expertise to help others.

If you are interested in this program, fill out this form.

Have you been involved with or had an impactful experience with the justice system or law enforcement (including police escorted 5150)?

First NameMiddle NameLast Name

Birth Date

MonthDayYear

Birthplace

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

E-mail Address

example@example.com

How Do You Identify?

MaleFemaleNon-binaryDecline/unknown

Primary Language

EnglishSpanishOther

Do you identify as any of the following race/ethnicities?

Hghest level of Education

Family Income Level:

Who referred you?

PROGRAM INTEREST

Are you interested in the following:

Industrial ArtsSocial MediaPeer Work

If you chose more than one option, then please tell us which ones you're interested in:

MEDICAL INFO

Have you ever been hospitalized, examined, or treated for psychiatric/emotional challenges?

YesNo

Are you currently receiving psychiatric services from another provider?

YesNo

Are you presently employed?

YesNo

If you are employed, please specify your occupation:

Do you receive any of the following?