EMPLOYERS AND AGENCIES: Submit your information for inclusion in the SWPA Re-entry Committee database, paper based Services Directory, and AboutFace CareerWired.com searchable database. NOTE: This data may also be used by the general public, any/all ex-offenders, and by program supported ex-offender clients......unless restricted use is specified in the submission.

Employment & Services Database

v beta 1.0

Agency Name:
Agency Address:
City/State/Zip:
Agency web address:
Contact Name:
Contact Title:
Contact Phone:
Contact email address:
Services Provided: Give a two or three sentence description of your agency:

Services Provided: Check the services your agency provides in each category:

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BASIC NEEDS:

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Food	Clothing	Shelter	ID/Legal Documents
Legal Assistance	Transportation	Medical/Prescriptions	Child/Family Assistance
Personal Vehicle	Voters Rights/Registration

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LIFE SKILLS AND RELATIONSHIPS

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Listening Skills	Time Management	Housekeeping Skills	Mentoring
Family Reunification	Parenting Skills	Victim-Offender Reconciliation	Leisure Activities/Hobbies
Religious/Spiritual Places	Personal Care/Hygiene

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FINANCIAL ASSISTANCE

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Personal Banking	Retirement Planning	Housing Assistance	Public Assistance
Child Support	Restitution	Money Management/Budgets	Last Will and Testament
Court Costs and Fines

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GENERAL AND MENTAL HEALTH CARE

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Basic Health Care	Diet & Nutrition	Family Planning	MH/MR Counseling
Addiction Therapy	Sexually Transmitted Diseases	Chronic Care/Hospitalization	Coping/Stress/Anger Management
Re-Entry Support Group

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EMPLOYMENT AND EDUCATION

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Job Search	Career Exploration	Entrepreneurship	Work Clothing
Tools/Kits/Licenses	Resume/Interview Prep	College Course Assistance	Welfare-to-Work Assistance
Workplace Skills Development

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Geographic Area Served:
Population Served:
Transportation Information:
Fee Structure:
Other:

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When the survey is complete, you can choose to either submit the form, or clear it. If you choose to clear it, you will lose ALL of the information that you have filled out (try it). If you choose submit, the information that you have entered will be passed along to the database and stored.





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Project Contact:
The FREEdLANCE Group
1100 Washington Avenue
Pittsburgh, PA 15106
Phone: 1-877-937-6638
fax: 412-429-7651
Email: fdefreitas@freedlance.com