North County Tattoo Removal Program 

PLEASE READ BEFORE COMPLETING THE SURVEY !
In order to qualify for the North County Tattoo Removal Program you  must meet the following criteria:
  1.  Be no older than 30
  2. Live in North San Diego County
  3. Have visible gang related tattoos (head, face, neck, hands)
  4. No longer have contact with gangs, gang members or gang activity

* 1. Name:

* 2. Age

* 3. Date of Birth

* 4. Gender

* 5. Are you currently on Probation or Parole?

* 6. Have you ever been arrested?

* 7. What was the date of your last arrest?

* 8. If arrested, what was the charge?

* 9. Where do you have tattoos?

* 10. How many tattoos do you have on your head, neck, face and/or hands?

* 11. My tattoos are (mark all that apply)

* 12. I consider my tattoo

* 13. I got my tattoo to represent a gang or gang life?

* 14. My tattoos have kept me from (mark all that apply)

* 15. Are you employed?

* 16. Are you attending school?

* 17. Have you earned your High School Diploma or GED

* 18. How did you hear about this program?

* 19. Why is it important to you to have your tattoo(s) removed?

* 20. Phone number:

* 21. Email address:

* 22. Address:

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100% of survey complete.

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