Jailhouse Cafe EligibilityFill out the form below to submit your information for a case manager to review. Name * First Name Last Name Date of Birth Address City, State Zip County Phone (###) ### #### Email * Answer the following. * If none of these apply to you you are not eligible! Child(ren) under age 18? Are you the custodial parent ? Do you have an order to pay child support? Do you have two forms of ID? (SS, ID, Birth Cert.) Do you have transportation? Are you, or were you in the military? Do you receive food stamps? Are you working with any other agencies? If Yes, who? Education Level? High School Diploma/ GED Some College Undergraduate and above None Of The Above Recently Incarcerated ? Yes No If Yes, When: Felony Record Yes No If Yes, Please Explain: Do you have any disorders or disabilities that we should be aware of? Thank you for your submission! You will hear back from soon!
