SOAR Client Registration Form
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Gender
*
Male
Female
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you ever been arrested (as a juvenile or as an adult)?
Yes
No
Have you ever been incarcerated (as a juvenile or as an adult)?
*
Yes
No
Were you released from incarceration within the last 6 months?
*
Yes
No
Are you currently under community supervision (i.e. house arrest, half-way house, recovery house, etc.)?
Yes
No
Are you currently on probation or parole?
Yes
No
Have you ever been convicted of a sex crime other than prostitution?
Yes
No
Are you currently employed?
Yes
No
Are you willing to participate in trainings for 2-10 weeks if they produce higher wages?
Yes
No
Submit
Should be Empty: