(404) 680-8893 | [email protected] | 75 Washington Street Ste 1146, Fairburn Ga 30213

Home
About Us
Donate
Get Help
Refer Somone
Contact

Intake Form

Basic Info

First Name

Last Name

Phone *

Date of release

Email *

Housing Status

What is your current housing situation?

Family Member
Friend
Case Worker
Probation / Parole
Employer
Community Member
Other
No elements found. Consider changing the search query.
List is empty.

Employment History

Last job or work experience

Are you currently employed?

Yes

Are you seeking employment assistance?

Identification Status

Do you currently have a valid ID?

Housing assistance

Employment support

Transportation

Identification documents

Mental health support

Substance recovery

Life skills coaching

Re-entry planning

Emergency stabilization

Not sure / needs assessment

Parole /Legal Conditions

Are you currently on parole or probation?

Yes

Do you need legal support or referrals?

Mental Health Support

Would you like mental health support services?

Current mental health concerns

Optional

Substance Recovery

Are you seeking substance recovery support?

Currently in recovery program?

Yes

Transportation Needs

Do you have reliable transportation?

Yes

Do you need transportation assistance?

I confirm the person being referred is aware or would benefit from being contacted.

By checking this box, I Consent to Receive SMS Notifications, Alerts & Upcoming Appointments from Closing Circles Inc. Message frequency may vary. Message & data rates may apply. Text HELP for assistance. You can reply STOP to unsubscribe at any time.

By checking this box, I Consent to Receive the Occasional Marketing Messages from Closing Circles Inc. You Can Reply Stop to unsubscribe at any time.

Let’s Work Together

Whether you’re a business, nonprofit, service provider, or community organization, partnering with Closing Circles helps create real pathways to stability and success.

We’re always looking for mission-aligned partners ready to make a difference.