Resources for Clients
Alternative Schools Network
Chicago City Colleges
Jobs for Youth
North Lawndale Employment Network
West Town Academy
Erie Neighborhood House
Are you 17-21? Have you been locked up? The odds are against your success.
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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.