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C.A.R.E. Coordinator Report
Person Re-Entering
First Name
Last Name
C.A.R.E. Coordinator (use name on LGL account)
First Name
Last Name
What data are you reporting?
Contact with Person Reentering
New Needs
Transporting/Accompanying Person Reentering
Resource Acquired
Provide Narrative on Progress
Upload a CARE Coordinator Report Related Document
Are you updating any information for this person?
Add Support or Emergency Contact
Change in CARE Coordinator
Change in Touch Level
New Contact Info
Demographic Info
Funding Eligibility
Blake Case Legal Info
Contact with Person Reentering
Contact Type
select one
Call
Meeting
In Person
JPAY
Social Media
Text Message
Facility
select one
Airway Heights Corrections Center (AHCC)
Cedar Creek Corrections Center (CCCC)
Clallam Bay Corrections Center (CBCC)
Coyote Ridge Corrections Center (CRCC)
Larch Corrections Center (LCC)
Mission Creek Corrections Center for Women (MCCCW)
MSU, Monroe Correctional Complex (MCC)
SOU, Monroe Correctional Complex (MCC)
TRU, Monroe Correctional Complex (MCC)
WSR, Monroe Correctional Complex (MCC)
Olympic Corrections Center (OCC)
Stafford Creek Corrections Center (SCCC)
Washington Corrections Center (WCC)
Washington Corrections Center for Women (WCCW)
Washington State Penitentiary (WSP)
Other
Date
(mm/dd/yyyy)
Hours
Contact Details
Check here to report another contact with same person reentering.
Check here
Contact Type #2
select one
Call
Meeting
In Person
JPAY
Social Media
Text Message
Facility
select one
Airway Heights Corrections Center (AHCC)
Cedar Creek Corrections Center (CCCC)
Clallam Bay Corrections Center (CBCC)
Coyote Ridge Corrections Center (CRCC)
Larch Corrections Center (LCC)
Mission Creek Corrections Center for Women (MCCCW)
MSU, Monroe Correctional Complex (MCC)
SOU, Monroe Correctional Complex (MCC)
TRU, Monroe Correctional Complex (MCC)
WSR, Monroe Correctional Complex (MCC)
Olympic Corrections Center (OCC)
Stafford Creek Corrections Center (SCCC)
Washington Corrections Center (WCC)
Washington Corrections Center for Women (WCCW)
Washington State Penitentiary (WSP)
Other
Date #2
(mm/dd/yyyy)
Hours #2
Contact Details #2
Check here to report another contact with same person reentering.
Check here
Contact Type #3
select one
Call
Meeting
In Person
JPAY
Social Media
Text Message
Facility
select one
Airway Heights Corrections Center (AHCC)
Cedar Creek Corrections Center (CCCC)
Clallam Bay Corrections Center (CBCC)
Coyote Ridge Corrections Center (CRCC)
Larch Corrections Center (LCC)
Mission Creek Corrections Center for Women (MCCCW)
MSU, Monroe Correctional Complex (MCC)
SOU, Monroe Correctional Complex (MCC)
TRU, Monroe Correctional Complex (MCC)
WSR, Monroe Correctional Complex (MCC)
Olympic Corrections Center (OCC)
Stafford Creek Corrections Center (SCCC)
Washington Corrections Center (WCC)
Washington Corrections Center for Women (WCCW)
Washington State Penitentiary (WSP)
Other
Date #3
(mm/dd/yyyy)
Hours #3
Contact Details #3
Check here to report another contact with same person reentering.
Check here
Contact Type #4
select one
Call
Meeting
In Person
JPAY
Social Media
Text Message
Facility
select one
Airway Heights Corrections Center (AHCC)
Cedar Creek Corrections Center (CCCC)
Clallam Bay Corrections Center (CBCC)
Coyote Ridge Corrections Center (CRCC)
Larch Corrections Center (LCC)
Mission Creek Corrections Center for Women (MCCCW)
MSU, Monroe Correctional Complex (MCC)
SOU, Monroe Correctional Complex (MCC)
TRU, Monroe Correctional Complex (MCC)
WSR, Monroe Correctional Complex (MCC)
Olympic Corrections Center (OCC)
Stafford Creek Corrections Center (SCCC)
Washington Corrections Center (WCC)
Washington Corrections Center for Women (WCCW)
Washington State Penitentiary (WSP)
Other
Date #4
(mm/dd/yyyy)
Hours #4
Contact Details #4
Check here to report another contact with same person reentering.
Please submit another form if you have more than five contacts to report.
Check here
Contact Type #5
select one
Call
Meeting
In Person
JPAY
Social Media
Text Message
Facility
select one
Airway Heights Corrections Center (AHCC)
Cedar Creek Corrections Center (CCCC)
Clallam Bay Corrections Center (CBCC)
Coyote Ridge Corrections Center (CRCC)
Larch Corrections Center (LCC)
Mission Creek Corrections Center for Women (MCCCW)
MSU, Monroe Correctional Complex (MCC)
SOU, Monroe Correctional Complex (MCC)
TRU, Monroe Correctional Complex (MCC)
WSR, Monroe Correctional Complex (MCC)
Olympic Corrections Center (OCC)
Stafford Creek Corrections Center (SCCC)
Washington Corrections Center (WCC)
Washington Corrections Center for Women (WCCW)
Washington State Penitentiary (WSP)
Other
Date #5
(mm/dd/yyyy)
Hours #5
Contact Details #5
New Needs
Date
(mm/dd/yyyy)
New Needs Expressed
Advocacy
Basic Supplies or Household Items
Behavioral/Mental Health Support
Birth Certificate or SS Card
Child Care
Child Welfare
Clothing
Driver's License
Education/Training
Employment
Employment Related Need
Financial
Food
Grief & Trauma Support
Health Care or Health Insurance
Housing
Hygiene Needs
Legal Support
LFOs
Meditation or NVC Training
Physical Health Support
School Engagement/Retention
Social/Emotional/Community Support
Spiritual Support
Substance Abuse Support
Support Based on Lived Experience
Tech Support or Device
Transportation
Veterans
Other
ADVOCACY
BASIC SUPPLIES OR HOUSEHOLD ITEMS
BEHAVIORAL/MENTAL HEALTH SUPPORT
BIRTH CERTIFICATE OR SS CARD
CHILD CARE
CHILD WELFARE
CLOTHING
DRIVER'S LICENSE
EDUCATION/TRAINING
EMPLOYMENT
EMPLOYMENT RELATED NEED
FINANCIAL
FOOD
GRIEF & TRAUMA SUPPORT
HEALTH CARE OR HEALTH INSURANCE
HOUSING
HYGIENE NEEDS
LEGAL SUPPORT
LFOs
MEDITATION OR NVC TRAINING
PHYSICAL HEALTH SUPPORT
SCHOOL ENGAGEMENT/RETENTION
SOCIAL/EMOTIONAL/COMMUNITY SUPPORT
SPIRITUAL SUPPORT
SUBSTANCE ABUSE SUPPORT
SUPPORT BASED ON LIVED EXPERIENCE
Examples: seeking specific resources that support folks who identify as LGBTQAI+, survivors of domestic violence, support related to leaving a gang, etc.
TECH SUPPORT OR DEVICE
TRANSPORTATION
VETERANS
OTHER
Transporting/Accompanying Person Reentering
Date
(mm/dd/yyyy)
Destinations
Details
Hours Transporting/Accompanying
Check here to report another transportation/accompanying of person reentering.
Check here
Date #2
(mm/dd/yyyy)
Destinations #2
Details #2
Hours Transporting/Accompanying #2
Check here to report another transportation/accompanying of person reentering.
Check here
Date #3
(mm/dd/yyyy)
Destinations #3
Details #3
Hours Transporting/Accompanying #3
Check here to report another transportation/accompanying of person reentering.
Check here
Date #4
(mm/dd/yyyy)
Destinations #4
Details #4
Hours Transporting/Accompanying #4
Check here to report another transportation/accompanying of person reentering.
Please submit another form if you have more than five to report.
Check here
Date #5
(mm/dd/yyyy)
Destinations #5
Details #5
Hours Transporting/Accompanying #5
Resource(s) Acquired
Resource(s) Acquired
Advocacy
Basic Supplies or Household Items
Behavioral/Mental Health Support
Birth Certificate or SS Card
Child Care
Child Welfare
Clothing
Driver's License
Education/Training
Employment
Employment Related Need
Financial
Food
Grief & Trauma Support
Health Care or Health Insurance
Housing
Hygiene Needs
Legal Support
LFOs
Meditation or NVC Training
Physical Health Support
School Engagement/Retention
Social/Emotional/Community Support
Spiritual Support
Substance Abuse Support
Support Based on Lived Experience
Tech Support or Device
Transportation
Veterans
Other
Date of Need Met (Advocacy)
(mm/dd/yyyy)
Details on Acquired Resource for Advocacy
Check here if acquired resource is connected to an expense.
Expense for Advocacy
Date of Need Met (Basic Supplies or Household Items)
(mm/dd/yyyy)
Details on Acquired Resource for Basic Supplies or Household Items
Check here if acquired resource is connected to an expense.
Expense for Basic Supplies or Household Items
Date of Need Met (Behavioral or Mental Health Support)
(mm/dd/yyyy)
Details on Acquired Resource for Behavioral/Mental Health Support
Check here if acquired resource is connected to an expense.
Expense for Behavioral/Mental Health Support Need
Date of Need Met (Birth Certificate or SS Card)
(mm/dd/yyyy)
Details on Acquired Resource for Birth Certificate or SS Card
Check here if acquired resource is connected to an expense.
Expense for Birth Certificate or SS Card Need
Date of Need Met (Child Care)
(mm/dd/yyyy)
Details on Acquired Resource for Child Care
Check here if acquired resource is connected to an expense.
Expense for Child Care
Date of Need Met (Child Welfare)
(mm/dd/yyyy)
Details on Acquired Resource for Child Welfare
Check here if acquired resource is connected to an expense.
Expense for Child Welfare Need
Date of Need Met (Clothing)
(mm/dd/yyyy)
Details on Acquired Resource for Clothing
Check here if acquired resource is connected to an expense.
Expense for Clothing
Date of Need Met (Driver's License)
(mm/dd/yyyy)
Details on Acquired Resource for Driver's License
Check here if acquired resource is connected to an expense.
Expense for Driver's License Need
Date of Need Met (Education/Training)
(mm/dd/yyyy)
Details on Acquired Resource for Education/Training
Check here if acquired resource is connected to an expense.
Expense for Education/Training Need
Date of Need Met (Employment)
(mm/dd/yyyy)
Details on Acquired Resource for Employment
Check here if acquired resource is connected to an expense.
Expense for Employment Need
Date of Need Met (Employment Related Need)
(mm/dd/yyyy)
Details on Acquired Resource for Employment Related Need
Check here if acquired resource is connected to an expense.
Expense for Employment Related Need
Date of Need Met (Financial)
(mm/dd/yyyy)
Details on Acquired Resource for Financial
Check here if acquired resource is connected to an expense.
Expense for Financial Need
Date of Need Met (Food)
(mm/dd/yyyy)
Details on Acquired Resource for Food
Check here if acquired resource is connected to an expense.
Expense for Food Need
Date of Need Met (Grief & Trauma Support)
(mm/dd/yyyy)
Details on Acquired Resource for Grief & Trauma Support
Check here if acquired resource is connected to an expense.
Expense for Grief & Trauma Support Need
Date of Need Met (Health Care or Health Insurance)
(mm/dd/yyyy)
Details on Acquired Resource for Health Care or Health Insurance
Check here if acquired resource is connected to an expense.
Expense for Health Care or Health Insurance Need
Date of Need Met (Housing)
(mm/dd/yyyy)
Details on Acquired Resource for Housing
File Upload for Housing Related Documents
File Upload for Housing Related Documents #2
File Upload for Housing Related Documents #3
Brief Description of Documents
Check here if acquired resource is connected to an expense.
Expense for Housing Need
Date of Need Met (Hygiene Needs)
(mm/dd/yyyy)
Details on Acquired Resource for Hygiene Needs
Check here if acquired resource is connected to an expense.
Expense for Hygiene Needs
Date of Need Met (Legal Support)
(mm/dd/yyyy)
Details on Acquired Resource for Legal Support
Check here if acquired resource is connected to an expense.
Expense for Legal Support Need
Date of Need Met (LFOs)
(mm/dd/yyyy)
Details on Acquired Resource for LFOs
Check here if acquired resource is connected to an expense.
Expense for LFOs Need
Date of Need Met (Meditation or NVC Training)
(mm/dd/yyyy)
Details on Acquired Resource for Meditation or NVC Training
Check here if acquired resource is connected to an expense.
Expense for Meditation or NVC Training Need
Date of Need Met (Physical Health Support)
(mm/dd/yyyy)
Details on Acquired Resource for Physical Health Support
Check here if acquired resource is connected to an expense.
Expense for Physical Health Support Need
Date of Need Met (School Engagement/Retention)
(mm/dd/yyyy)
Details on Acquired Resource for School Engagement/Retention
Check here if acquired resource is connected to an expense.
Expense for School Engagement/Retention
Date of Need Met (Social/Emotional/Community Support)
(mm/dd/yyyy)
Details on Acquired Resource for Social/Emotional/Community Support
Check here if acquired resource is connected to an expense.
Expense for Social/Emotional/Community Support Need
Date of Need Met (Spiritual Support)
(mm/dd/yyyy)
Details on Acquired Resource for Spiritual Support
Check here if acquired resource is connected to an expense.
Expense for Spiritual Support Need
Date of Need Met (Substance Abuse Support)
(mm/dd/yyyy)
Details on Acquired Resource for Substance Abuse Support
Check here if acquired resource is connected to an expense.
Expense for Substance Abuse Support Need
Date of Need Met (Support Based on Lived Experience)
(mm/dd/yyyy)
Details on Acquired Resource for Support Based on Lived Experience
Check here if acquired resource is connected to an expense.
Expense for Support Based on Lived Experience Need
Date of Need Met (Tech Support or Device)
(mm/dd/yyyy)
Details on Acquired Resource for Tech Support or Device
Check here if acquired resource is connected to an expense.
Expense for Tech Support or Device Need
Date of Need Met (Transportation)
(mm/dd/yyyy)
Details on Acquired Resource for Transportation
Check here if acquired resource is connected to an expense.
Expense for Transportation Need
Date of Need Met (Veterans)
(mm/dd/yyyy)
Details on Acquired Resource for Veterans
Check here if acquired resource is connected to an expense.
Expense for Veterans Need
Date of Need Met (Others)
(mm/dd/yyyy)
Details on Acquired Resource for Other
Check here if acquired resource is connected to an expense.
Expense for Other Need
Organization or Person that provided any resource(s) listed above (optional)
Check which resources from above were acquired from this contact.
Basic Supplies or Household Items
Behavioral/Mental Health Support
Birth Certificate or SS Card
Child Care
Child Welfare
Clothing
Driver's License
Education/Training
Employment
Employment Related Need
Financial
Food
Grief & Trauma Support
Health Care or Health Insurance
Housing
Hygiene Needs
Legal Support
LFOs
Meditation Training
NVC Training
Physical Health Support
School Engagement/Retention
Social/Emotional/Community Support
Spiritual Support
Substance Abuse Support
Support Based on Lived Experience
Tech Support or Device
Transportation
Veterans
Other
Check here if another organization provided resources identified above (optional)
Check here
Organization or Person #2 that provided anys resources listed above (optional)
Check which resources from above were acquired from this contact #2.
Basic Supplies or Household Items
Behavioral/Mental Health Support
Birth Certificate or SS Card
Child Care
Child Welfare
Clothing
Driver's License
Education/Training
Employment
Employment Related Need
Financial
Food
Grief & Trauma Support
Health Care or Health Insurance
Housing
Hygiene Needs
Legal Support
LFOs
Meditation Training
NVC Training
Physical Health Support
School Engagement/Retention
Social/Emotional/Community Support
Spiritual Support
Substance Abuse Support
Support Based on Lived Experience
Tech Support or Device
Transportation
Veterans
Other
Check here if another organization provided resources identified above (optional)
Check here
Organization or Person #3 that provided any resources listed above (optional)
Check which resources from above were acquired from this contact #3.
Basic Supplies or Household Items
Behavioral/Mental Health Support
Birth Certificate or SS Card
Child Care
Child Welfare
Clothing
Driver's License
Education/Training
Employment
Employment Related Need
Financial
Food
Grief & Trauma Support
Health Care or Health Insurance
Housing
Hygiene Needs
Legal Support
LFOs
Meditation Training
NVC Training
Physical Health Support
School Engagement/Retention
Social/Emotional/Community Support
Spiritual Support
Substance Abuse Support
Support Based on Lived Experience
Tech Support or Device
Transportation
Veterans
Other
Narrative on Progress
Provide Narrative on Progress
Include here progress, challenges, questions, etc.
Upload a CARE Coordinator Report Related Document
File Upload for CARE Coordinator Related Document
This might include a PDF, Word Document, Excel Document, etc.
File Upload for CARE Coordinator Related Document #2
This might include a PDF, Word Document, Excel Document, etc.
File Upload for CARE Coordinator Related Document #3
This might include a PDF, Word Document, Excel Document, etc.
Brief Description of Documents
Add Support or Emergency Contact
Support/Emergency Contact
First Name
Last Name
Relationship
Phone
Email
Verify Email
Detail on relationship with person re-entering
Change in C.A.R.E. Coordinator
Name of New CARE Coordinator
First Name
Last Name
Change in Touch Level
Previous Touch Level
select one
Low
Medium
High
New Touch Level
select one
Low
Medium
High
Update Contact Info
Phone
Email
Verify Email
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Update Demographic Info
Birthdate
(mm/dd/yyyy)
Race and/or Ethnicity
Primary Language
What best describes your gender?
Options may include (cisgender or trans) male, (cisgender or trans) female, nonbinary, gender fluid, two-spirit, intersex, etc.
What gender pronouns do you use?
select one
they/them
she/her
he/him
other (see below)
If you use gender pronouns not included in the list above, please identify those here.
Zipcode of Residence or Release
Have you ever served in the military?
select one
Yes
No
Unsure
Update Funding Eligibility
Funding Eligbility
Certain aspects of this person's situation may qualify them for funding we have for specific populations, locations, etc. This section may change depending on the funding we have available. Please check each situation that applies to this person.
Has a connection to Seattle (employment, displaced from Seattle, etc.)
Has a connection to Seattle (employment, displaced from Seattle, etc.) AND is under 30 and identifies as Black, Indigenous, or Latinx
Has a connection to the King County community (lives, has ever lived, works or worked in, has family in - just a very loose connection needed) and has a drug or drug-related arrest records, criminal charges and/or convictions
Impacted by gun violence AND is between 12 to 24 years old
Based in the Spokane area
Check any relevant situations here - this information may qualify them for assistance or may be required for reporting in order to utilize assistance.
Person is receiving state health insurance (such as AppleHealth or Medicaid)
Person is houseless (which includes couch surfing, utilizing emergency housing/hotels, etc)
Person has a disabling condition
Person is a minor or has minor children in their household
Person is a veteran
Person is unemployed
Person is currently fleeing domestic violence
Blake Case Legal Intake
Do you have any aliases?
Are you a US citizen?
select one
Yes
No
Prefer Not to Say
Other
Legal Matter
What is the Date you were convicted or found guilty of your possession of a controlled substance; your "Blake" matter?
(mm/dd/yyyy)
How many times have you pleaded guilty to or been wrongfully convicted of possession of a controlled substance?
Were all of the convictions or guilty findings in the same County or in Different Counties?
select one
Same County
Different Counties
Case Number
Conviction Date
(mm/dd/yyyy)
County of Conviction
Associated Cost
select one
Fees
Fines
Are these costs fully paid off?
select one
Yes
No
Unknown
Total Amount Remaining to be Paid
Please indicate if you are seeking re-sentencing or dismissal of your "Blake" issue.
select one
Re-sentencing
Dismissal
Would the outcome of your "Blake" issue cause an...
select one
Immediate release from custody
Immediate release from community custody
Unsure
Other
What outcome would you like to see?
Please indicate what relevant documents you have.
Judgment and sentence
Certificate of Discharge
Receipts from Payment
No Contact Orders
DOC forms
Any other documents related to your case
Please list other documents
Ancillary Issues
Ancillary Issues: What other issues might the "Blake" decision affect?
These are any issues that if the "Blake" decision is expunged/vacated would be affected as well.
Citizenship
Community Custody
LFO's (reimbursement and/or current payments)
Other Charges (would no longer be applicable).
Points for my offender score (every felony is one point)
Unsure
Any other documents related to your case(s)
Other Parties
Do you have any co-defendants that this may affect?
If yes, please provide name(s).
Have you had counsel for the "Blake" matter?
If yes, please provide name and any contact information.
Toolkit packet received?
Toolkits provide information on the Blake case decision and processes for getting conviction vacated, expunged record, refunded LFOs, etc.
Yes
Not yet, but expressed interest
Declined
Date Toolkit Received
(mm/dd/yyyy)
Additional Notes
If this person has not had an intake form submitted for them, please note the date of the first contact.
(mm/dd/yyyy)
What program is this person in?
Credible Allies is a specific program for Black, Indigenous, and People of Color under the age of 30. Safe Return is for all other folks reentering in the Puget Sound/Western Washington area. Freedom Project East is for people reentering in Eastern Washington and the Spokane area.
select one
Safe Returns
Credible Allies
FP East
Support for Family or Loved Ones of Impacted Folks
Report Form Completed By
First Name
Last Name