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TAGIT Application
Please download, complete, and return the following application to our office, or upload it below.
CLICK TO DOWNLOAD
TAGIT Online Application
PERSONAL DATA INFORMATION:
*
Indicates required field
Name
*
First
Last
Today's Date
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Home Phone
*
Cell Phone
*
Work Phone
*
Date Of Birth
*
Choose One
*
Male
Female
Current Employment Status
*
Select One
Unemployed
Part-time
Full-time
Self-employed
Other
Place Of Employment
*
Highest Level Of Education
*
Select One
Some Middle School
Middle School
Some High School
GED
Completed High School
Technical School
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
Current Grade In School
*
Select One
6th
7th
8th
9th
10th
11th
12th
None Of The Above
School Currently Attending
*
EMERGENCY CONTACT INFO:
Name Of Emergency Contact
*
First
Last
Email
*
Relationship To Applicant
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Home Phone
*
Cell Phone
*
Work Phone
*
OTHER INFORMATION:
Name Of Person Who Referred You To TAGIT
*
First
Last
Phone Number
*
Name Of Caseworker
*
First
Last
Phone Number
*
LEGAL HISTORY:
Are You Legally Mandated To Participate In The TAGIT Program?
*
Yes
No
If Yes, By Whom?
*
Court
Other
Explain
*
If Answer Is Court, Please List County Of Origin
*
Are You Currently, Or Will You Be Under Legal Supervision?
*
Yes
No
Maybe
Unsure
If You Answered Yes, What Is Your Method Of Reporting?
*
Phone
Letter
Email
Online
In Person
Other
Check All That Apply
If You Answered Other, Please Explain:
*
How Often Do You Report?
*
Time Remaining:
*
Name Of Probation Officer
*
First
Last
Agency
*
Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Are Any Of The Following Pending Against You?
*
Arrest Warrant
Court Appearance
Criminal Charges
Sentencing
None Of The Above
Please Check All That Apply
If You Checked Any Of The Above, Please Explain:
*
List All Arrests And Convictions:
Date
*
Charges
*
Conviction
*
Yes
No
Were Drugs Involved?
*
Yes
No
Was Alcohol Involved?
*
Yes
No
Sentence
*
Time In Jail
*
Date
*
Charges
*
Conviction
*
Yes
No
Were Drugs Involved?
*
Yes
No
Was Alcohol Involved?
*
Yes
No
Sentence
*
Time In Jail
*
Date
*
Charges
*
Conviction
*
Yes
No
Were Drugs Involved?
*
Yes
No
Was Alcohol Involved?
*
Yes
No
Sentence
*
Time In Jail
*
Date
*
Charges
*
Conviction
*
Yes
No
Were Drugs Involved?
*
Yes
No
Was Alcohol Involved?
*
Yes
No
Sentence
*
Time In Jail
*
Date
*
Charges
*
Conviction
*
Yes
No
Were Drugs Involved?
*
Yes
No
Was Alcohol Involved?
*
Yes
No
Sentence
*
Time In Jail
*
Have You Ever Been In Detention Or Prison?
*
Yes
No
Additional Comments
*
Did Anyone Assist The Applicant In Filling Out This Form?
*
Yes
No
If Yes, Please List The Name Of The Person
*
Relationship Of Person To Applicant
*
Phone Number
*
Optional File Upload
*
Max file size: 20MB
Optional File Upload
*
Max file size: 20MB
The undersigned student applicant fully acknowledges that the information provided herein is accurate and true to the best of his or her knowledge, and that the application form has been completed and filled out by the student applicant by him/herself. Student applicant further understands that any false or incomplete information may cause and result in disqualification from admittance into the program, whether the student is just entering into, or is already in the program.
Electronic Signature Of Applicant
*
Date
*
Submit
Home
Gathering Details
I'm New
What We Believe
Community
Marketplace Ministry
Life Groups
Couples
Singleness Group
Men
Women
Catalyst (Youth)
Kids
Connect
Contact
Prayer List
Marketplace Directory
Who We Are
PASTORS
Worship Team
Creative Team
Media Team
T.A.G.I.T.
Give
MORE
Missions
Halloween Outreach 2020
Forms
Baptism & Baby Dedication