ACE FORM (INDIVIDUAL)

Address

Ethnicity Identification

Eligibility (check all that apply)

If formerly incarcerated, please enter your release date:

DD/MM/YYYY

If certified as a CPSS, please enter the certification date:

DD/MM/YYYY

Name of Event / Training you plan to attend: *

Required

Event / Training Location

Website

Event Training Website (if applicable)

Statement of Purpose

In the spaces provided below, please write a brief statement explaining your goals related to this particular event. Answer these three (3) questions.

1. What is it you hope to learn/achieve by attending? (Required) *

Required

2. What will you do with the information you receive at this event / training? (Required) *

Required

How will you share this information with others in the community? (Required) *