Department of Corrections "*" indicates required fields Last Name* First Name* Gender*MaleFemaleTransgenderSBI#* Inmate#* Date of Birth* MM slash DD slash YYYY Special Needs*NoneHandicap Accessible FacilityMental IllnessKnown Drug/Alcohol AbuseOtherDesired Location* Release Date* MM slash DD slash YYYY Type of Release*Max OutParoleProbationPre-AdjudicatedOtherCurrent Offense* Highlighted Criminal History (Use Ctrl for multiple selection)*NoneDrug DistributionSex OffenseArsonOtherHas the client ever used Emergency Assistance benefits for housing: No Yes Unsure If so, how long? Additonal Notes:Attach FileAccepted file types: pdf, jpg, doc, xls, png, gif, Max. file size: 100 MB.Requester InformationRequester Last Name* Requester First Name* Requester Email* Requester Fax #:Facility Name:* Requester Phone #:*CAPTCHA