Dear Applicant,
Passages is a place where women can begin again by learning to put the pieces of their lives back together. We are glad that you are at a time in your life when you see change as a positive decision.

Please review these program policies carefully. If you choose to apply to our program, call and schedule an interview upon your release or have the pre-release worker, case manager, probation officer, or attorney contact us for an interview in person or by phone at (605) 939-0744.

Before filling out and submitting this Pre-Application for the Passages Program, you must have read the Program Description and Policies document.

If you want to apply, fill out the Pre-Application below with your release worker or print and mail it to us:

Passages
P.O. Box 9614
Rapid City, SD 57709
Residency at Passages will be dependent upon the interview and space availability.


Pre-Application

Name *
Name
Are you currently incarcerated? *
Have you been incarcerated before? *
Where and Dates
When is your parole/review date?
When is your parole/review date?
When is your release date?
When is your release date?
Date of last use:
Date of last use:
Have you ever been hospitalized for mental/emotional problems? *
Where and Dates
Are you pregnant? *
If yes, when are you due?
If yes, when are you due?
Have you received prenatal care?
Have you ever been treated for attempted suicide?
If yes, when?
If yes, when?
Do you have any physical conditions that require medication? *
SSI/SSD? *
Have you applied for SSI/SSD?
Will you apply for SSI/SSD?
Have you ever lived in Transitional Housing before? *
What type of treatment have you received in the past: (check all that apply):