Connecting Families

Connecting You With Your Loved One Phone Application Form
The information submitted is confidential, Life Beyond Bars Inc, will not share or rent the information provided.
Do you give LBB permission to add money to your account or your loved one's account?*

YesNo
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use correct spelling of the inmate's name and inmate number.
I. Personal Data:

Tell us about yourself
Full Name*

First NameLast Name
Mobile No. :*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
Home Address :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Statistical Informations :

Information regarding gender, ethnic origin and race are optional. The information is requested for data gathering and report generation only. In no way will the information affect selection for the reward.
Gender:

MaleFemale
Are you a US citizen?

YesNo
Ethnic Origin:

HispanicNon-HispanicNot Indicated
Race? (Choose one or more):

WhiteBlack or African AmericanAsianAmerican Indian or Alaskan Native Hawaiian or Other Pacific Islander
Have you submitted an application for consideration previously?

YesNo
If yes, please specify when:

0/300
II. Information About Loved One:
Loved One ID Number *
Loved One Full Name *
Birthdate:*

MonthDayYear
Name of Federal or State Facility *
Address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is Your Loved One Sentence?*
Optional
III. Extras:
Are you interested in joining our Family Support Group?

YesNo
If Yes, Please advise the Best Time to Contact You?
VI. Essay
Please advise why you are the best candidate for the award.
0/500
VII. Applicant's E-Signature
Notice: To ensure your loved one receives the monetary award, it's important to confirm the information above is correct. If not, we will be unable to deposit money to the account and you forfeit the award.

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Should be Empty:

Connecting You With Your Loved One Phone Application Form

I. Personal Data:

II. Information About Loved One:

III. Extras:

VI. Essay

VII. Applicant's E-Signature