Intervention Services & Program Interest Form

Intervention Services & Program Interest Form

Please fill out and submit this form to request information about ARMS intervention groups or to begin the enrollment process.
Please note: We are not currently accepting new mandated referrals at this time.

We thank you for your interest and apologize for any inconvenience.
What is your full name?

First NameLast Name
What is the best phone number for us to reach you?
Please enter a valid phone number.Format: (000) 000-0000.
At what email would you like to receive program and/or appointment information?
example@example.com
How did you hear about ARMS programs?
Are you inquiring about ARMS Intervention programs for yourself or someone else?
Is your interest in ARMS Intervention programs related to any court proceedings?
Please select the source of your court mandate:
What county & state is your case in?
Name of court official supervising your case (probation or parole officer, caseworker, clerk of court, etc.):
Which ARMS Intervention program are you interested in?
Are you interested in enrolling?
How soon would you like to join a group if you enroll?
Would you be open to one-on-one sessions with an ARMS facilitator?
Is there anything else you would like us to know about your situation before we call?
Thank you for your interest in ARMS Intervention programs. Submissions are reviewed regularly and we will reach out with more information or to begin your enrollment within 1-2 business days.
Should be Empty: