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North Carolina Criminal Justice Resource Directory

for Service Groups, Offenders' and their Families

DIRECTORY INFORMATION SHEET

Part I: Directory Information (please check all that apply)

___ I am new to the NC-CJR directory, please list all of my information both online and printed.

Include: ___ Appointment required

Include: ___ Call before coming to agency

Include: ___ No phone calls; Court-imposed program

___ I am listed in the Directory, however, please make the changes below to my information.

___ Do not list or publish my information within the directory.

PART II: Service Group Information

Organization/Agency : ________________________________________________________

If based out of a religious organization, please name:

___________________________________________________________________________

Director: ________________________________________________________

First Last

Mailing Address: ____________________________________________________________________

____________________________________________________________________

City State Zip Code

Street Address: ____________________________________________________________________

(if different from mailing)

____________________________________________________________________

City State Zip Code

County: _____________________________

Email Address: ______________________________Phone Number: ______________

(will not be listed in directory)

Website: _________________________________________________________

# of Full-Time Staff: ___ 5 or less ___ 6 – 10 ___ More than 10

Year Founded: __________

Annual Budget: ____ Less than $50,000 ____ $50,000 - $150,000 ____ more than $150,000

Type of Agency: (please check all that apply)

___ Sentencing Services ___ Drug Treatment Court ___ Substance Abuse Treatment

___ Residential Treatment Program ___ Job Training/Placement ___ Re-entry

___ Mediation/Intervention ___ Prevention ___ Counseling

___ Mental Health Treatment ___ Women's Services ___ Adult Services

___ Juvenile Services ___ Peer to Peer Support Group ___ Family Housing

___ Offender Housing ___ Crime Victims' Services ___ Offenders' Family Services

___ Faith/Religious-based ___ Legal Assistance/Advice ___ Sex Offender Services

___ Batterer's Program

Programs : (Please list the programs provided and program director's name and contact information if different from primary agency director)

Program Name 1: _________________________________________________________

Program Director 1: _________________________________________________________