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.
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
Counselor or therapistPastor or spiritual leaderCourt mandateFriend or familyWebsite or online searchOther
For myselfFor someone elseGeneral information
Pending DV caseDivorceChild custodyODHS or CPS family caseProtection orderPretrialNone
Probation officerDeferred sentencing agreementODHS
What county & state is your case in?*
Name of court official supervising your case (probation or parole officer, caseworker, clerk of court, etc.):
ManKind (for men)Virtue (for women)Not sure yetGeneral program information
Yes, I would like to enroll as soon as possible.Yes, but I am not ready to enroll yet.I may be interestedJust gathering information.
How soon are you planning to join a group if you enroll?
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: