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Citizens Circle Registration
Note: Citizen Circle is no longer meeting at Clark County Public Library. Please join us at the Department of Reentry at 1101 E. High St. Springfield OH (Building 3).
*
1.
First and Last Name
(Required.)
*
2.
Phone Number
(Required.)
3.
Email Address
*
4.
Have you ever been incarcerated?
(Required.)
Yes
No
5.
If you answered yes on Q4, what is your most recent release date?
*
6.
What topics do you hope to discuss at Citizens Circle?
(Required.)
*
7.
What do you hope to gain from joining Citizens Circle?
(Required.)
8.
Justice-impacted citizens participating in Citizens Circle are eligible for a $20 gas card or a Field Trips transportation pass. Which option best meets your needs?
Transportation Pass/Field Trips
Gas Card