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Thanks for your interest in Acivilate and the Pokket platform!
Please complete this form and one of our Agency Relations team members will contact you.
First name
*
Last name
*
Title
*
Organization
*
Email
*
Phone number
*
Choose Preferred Contact Method
*
Email
Phone
What type of Organization do you represent?
*
Please Select
Government
Criminal Justice Agency
Health/Human Services
Medical Provider
Mental Health Provider
Substance Abuse Assistance
Non-Profit or Service Organization
What is the type of jurisdiction your organization serves?
*
(If you do not see your jurisdiction type, please select Other and enter additional details in the space below)
Please Select
City
County
State
Federal
Tribal
Other
Other Jurisdiction Type
Choose Your Program Type
*
(If you do not see your program type, please select Other and enter additional details in the space below)
Probation Supervision
Parole Supervision
Pre-Trial Supervision
Other Community Supervision
Prison Reentry
Jail Reentry
Drug Court Program
Family Court Program
Veterans Court Program
Community Court Program
Tribal Court Program
Other Program Type
Other Program Type
How many Participants are part of your program?
(Participants, Clients, Program Members, etc.)
Participant Age Range
Program Duration
(Include whether program is cohort-based or other type)
Submit