Consulting Services Inquiry Form
Complete this inquiry form to share your contact information, program interest, current situation, needs, and any relevant details so the team can follow up appropriately.
Contact Information
Full Name
*
First Name
Middle Name
Last Name
Preferred Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Phone
Email
Text Message
Current Situation and Needs
Current situation
*
Currently incarcerated
Recently released
Preparing for release
On probation
On parole
Previously incarcerated
Justice-involved family member
Supporting someone incarcerated/returning
Community member
Organization/service provider
Other
Primary challenges or needs
*
Mental health/wellness
Trauma
Family relationships
Reunification with children
Parenting
Employment
Housing
Education
Life skills
Emotional regulation
Substance-use recovery
Community reintegration
Identity/self-esteem
Communication
Creative expression
Mentorship
Other
What would you like to accomplish through participation in a Pathways to Freedom program?
*
Most important goals right now
Emotional wellness
Family relationships
Reconnect with children
Prepare for release
Transition back
Life skills
Decision-making
Coping skills
Employment
Community resources
Share my story
Creative skills
Leadership skills
Support network
Other
Fathers Behind Bars
Are you a father who is currently or previously incarcerated, or completing this form on behalf of a father?
*
Yes
No
Completing this form on behalf of a father
How many children are involved?
1
2
3
4+
What would you most like support with?
*
Rebuilding my relationship with my child/children
Communication with my child/children
Parenting while incarcerated
Preparing for reunification
Parenting after release
Emotional support
Understanding my child's needs
Developing a healthy co-parenting relationship
Other
Tell us about your family goals
Behind the Inc & Mic
What type of creative expression interests you?
Writing
Poetry
Spoken Word
Podcasting
Storytelling
Interviews
Music
Video/Media
Publishing
Other
What would you like to share or create?
What do you hope your story or creative work will accomplish?
Inspire others
Educate others
Encourage positive change
Process my experiences
Advocate for reform
Build confidence
Develop creative skills
Create something for my children/family
Explore publishing/media opportunities
Other
Reentry Wellness
Where are you in your reentry journey?
Preparing for release
Released within the last 30 days
Released within the last 6 months
Released within the last year
More than one year post-release
Supporting someone through reentry
What areas would you like support with?
Mental health
Emotional regulation
Coping skills
Life skills
Employment
Housing
Transportation
Education
Family reunification
Community resources
Peer mentorship
Goal setting
Other
Behavioral Health Support
What type of support are you seeking?
Individual support
Group support
Mental health education
Trauma-informed support
Emotional wellness
Stress management
Coping skills
Anger/emotional regulation
Adjustment after incarceration
Family support
Other
Are you currently connected to a behavioral health provider?
Yes
No
Unsure
Prefer not to answer
Organizations & Community Partners
Organization Name
Your Position/Role
What are you interested in?
Bringing a Pathways program to our organization
Referring individuals to a program
Co-developing a program
Hosting a program
Staff training
Community workshop
Program consultation
Program evaluation
Community partnership
Other
Tell us about your organization's needs
Availability
When would you prefer to participate?
*
Weekday mornings
Weekday afternoons
Weekday evenings
Weekends
Flexible
Preferred format
*
In person
Virtual
Hybrid
No preference
Submit
Should be Empty: