Department of Corrections Clients NameName* First Last Gender*MaleFemaleTransgenderSBI#* Inmate#* Date of Birth* MM slash DD slash YYYY Special Needs*Handicap Accessible FacilityMental IllnessKnown Drug/Alcohol AbuseN/AUnknownLast Known Address* Street Address City State / Province / Region ZIP / Postal Code Release Date* MM slash DD slash YYYY Type of Release*Max OutParoleProbationPre-AdjudicatedUnconfirmedNACurrent Offense* Criminal History (Use Ctrl for multiple selection)*Drug DistributionSex OffenderArsonistNoneWill AttachHas the client ever used Emergency Assistance benefits for housing:* Yes No If so, How long? Additonal Notes:Attach FileAccepted file types: pdf, jpg, doc, xls, png, gif, Max. file size: 100 MB.Requester InformationName* First Last Facility Name:* Email* Phone:*Fax:CAPTCHA