clients

Resources for Clients

Alternative Schools Network

Safer Foundation

Chicago City Colleges

Jobs for Youth

North Lawndale Employment Network

West Town Academy

Inspiration Cafe

Erie Neighborhood House

Are you 17-21? Have you been locked up? The odds are against your success.

Join Tabula Rasa. Check out this month's calendar here.

We want you to succeed. We know you have it in you.

Sign up below for an opportunity to start from the beginning.

Clients

Confidential Client Registration Form

Name:

Date of Birth:

Phone Number:

Address:

Do you have a state ID?

When were you last incarcerated?

Where were you last incarcerated?

Have you ever been found guilty of a violent offense?

Have you ever been found guilty of a sex crime?

Are you currently on parole or probation?

If so, please list the details of your parole/probation below:

What is the highest level of education you have received?

Are you employed?

If so, where are you employed?

Please describe your current living situation:

Do you have any children?

If so, how many children do you have?

What special skills do you have?

What are your interests?

Please list 3 goals you would like to accomplish this year:
1.
2.
3.

By clicking "submit" you are providing an electronic signature.  
I understand that all of the information I have voluntarily provided will be held confidential by Tabula Rasa.
I understand that by participating in Tabula Rasa that I may be photographed.  I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders.  producers, sponsors, organizers and/or assigns.
This waiver shall be construed broadly to provide a release and waiver to the maximum extent permissable under applicable law.  
By clicking submit I hereby certify that I have provided honest responses, read this document and I understand its contents.