Christian Brother Application Please enable JavaScript in your browser to complete this form.First Name *Middle NameLast Name *Date of Birth *Social Security Number *Email *GDOC Number *Date Current Incarceration Began *Sentence Length in Years (or enter "Life" if appropriate). *Anticipated Release DateMaximum Possible Release Date *Reason for Present IncarcerationCurrent Prison *Marital Status *SingleMarriedLiving Common LawSeparatedDivorcedWidowerAre you currently in a romantic relationship (emotional or physical)? *YesNoHave you been convicted of a sexual crime? *YesNoHave you been convicted of arson. *YesNoList every hold on you from any other jurisdiction, whether local, county, state, federal, in or out of Georgia. This may include police, sheriff, courts, parole officers, or probation officers. State if the hold requires you to report somewhere else following your present incarceration. If none, enter "None". *If you would like us to reach out to the chaplain or a counselor concerning your application, please provide the person(s) full name, title, phone number and email. Please advise any person(s) you list that we may be contacting them.Please provide up to three references (preferably persons not presently incarcerated) if possible. Include each person's full name, address and phone number.Please provide your personal testimony - a detailed story of how Jesus found you and what your life with Jesus is like now. Be personal, not theoretical (e.g., how you came to Christ, how God has changed your life, etc.). *Describe any biblical studies or correspondence courses you have pursued. Indicate if the course was completed or not. If the course was graded, include the grade. If no studies or courses were pursued, enter "None". *What Disciplinary Reports have you had in the last year and why did you receive them? If none, enter "None". *Where would you like to be in 5 years? *By entering my full name below I hereby certify that the information provided on this application is true and accurate to the best of my ability, that it is provided in confidence and that it will be used, in part, to determine my potential for admission to the Newpoint Partnership program. I understand that this application is not a guarantee of my admission. *Date *Submit