Frederick Douglass Prison Visit Application — Workforce Development

Wednesday, September 10 — Elayn Hunt Correctional Center

Step 1 of 8 – Frederick Douglass Project Application

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Contact Information

Your Name(Required)

First Last

Email(Required)

Phone(Required)

Data Entry Disclaimer

The following information entered into this online form will be used by Parole Project staff to fill out forms required by the Department of Corrections. This information will be confidential and used only for purposes related to your involvement in Frederick Douglass Project prison visit sessions. By entering your name in “electronic signature” fields, you agree to use your response in this form instead of a traditional signature. If you have any questions or concerns, please contact: Matthew Pineda – Community Engagement Manager – 985-707-3466 – matthew@paroleproject.org

Rules and Guidelines for Volunteers or Guests

Below are rules meant as a summary of what is expected of volunteers or guests entering a Department of Public Safety and Corrections unit. Any problems, questions, or concerns should be addressed to the staff contact or appropriate security person. By signature below, the volunteer or guest acknowledges and understands the importance of following these rules and guidelines and that a violation of these or any other unit rule or guidelines may result in immediate and future termination of service and/or removal from the unit.

Please check each box to indicate you understand and agree to follow these rules. You will not be able to move forward unless you do so.(Required)

1. All visits to the unit must be approved in advance by the Unit Head or designee.

2. All personal vehicles must be parked in the parking lot at the Front Gate (or other designated area) unless authorized to drive in.

3. When unattended, the vehicle must be locked with the windows up and the keys removed.

4. All guests are subject to a search of themselves and their vehicle before entering the unit.

5. All vehicles, including the trunk area, will be checked by the Front Gate Security Officers upon leaving an institution.

6. Posted speed limits on institutional grounds will be adhered to.

7. Intoxicating liquors, weapons, drugs, cell phones, or any other articles, substances, or things that may be considered to endanger security will not be brought into or stored in any part of the unit. This includes a parked, locked vehicle.

8. No cameras, tape players, recorders, etc. can be brought into the unit without the express permission of the Unit Head or designee.

9. Nothing, including food items, drinks, metal utensils, religious literature, pamphlets, etc. is to be carried into the unit unless prior approval has been granted by the Unit Head or designee.

10. No one may enter the unit under the influence of alcohol or other intoxicants. An odor of alcohol is sufficient to deny entry. Medication must be checked at the Front Gate (or designated area) before entering the unit.

11. Institutional guests are not allowed to wear the following combinations of clothing since offenders wear these combinations: blue jeans and blue chambray shirt; blue jeans and a white tee shirt; blue jeans and sweat shirt; sweat suits or blue jean jackets.

12. Guests are allowed only in the area or areas where they have been given permission to be.

13. Unless authorized, no guest will bring anything to an offender, take anything from an offender or assist an offender in passing something to someone else.

14. Guests SHALL NOT develop nonprofessional relationships with offenders, with an offender’s family or with an offender’s friends. This includes, but is not limited to, the writing of personal letters and making personal phone calls to offenders, offenders’ family or friends.

15. No money can be given to an offender by anyone for any reason.

I understand and agree to follow these rules.(Required)

Yes

Volunteer Registration and Agreement

Full Name(Required)

As it appears on your ID.

Prefix First Middle Last Suffix

Drivers License Number(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Height (ft.)(Required)

Height (in.)(Required)

Weight(Required)

Example: 175 lbs.

Race(Required)

Sex

Social Security Number(Required)

To protect your identity and data, a Parole Project staff member will call you to securely record your Social Security number. Please select “I agree” to indicate you understand.

I agree

I do not agree

Address(Required)

As listed on your ID

Street Address Address Line 2 City State ZIP Code

Phone Numbers(Required)

Please select all applicable options that can be used to contact you.

Cell Phone

Home Phone

Work Phone

Fax

Cell Phone Number(Required)

Home Phone Number(Required)

Work Phone Number(Required)

Fax Phone Number(Required)

Have you ever been arrested?(Required)

Yes

Have you ever been convicted of a felony?(Required)

Yes

Have you ever been on probation or parole?(Required)

Yes

If you answered yes to any of the above questions, please explain (include charge, when, where, DOC number, parole or probation officer's name)(Required)

Enter “N/A” if not applicable

Aliases(Required)

Enter “N/A” if not applicable

Are you related by blood or marriage to any offender housed in a DPS&C facility?(Required)

Yes

If yes, whom? (Name, DOC number, and location of offender)(Required)

Enter “N/A” if not applicable

Have you or any member of your family been the victim of a crime?(Required)

Yes

If yes, what was the crime?(Required)

Enter “N/A” if not applicable

Where is/was the offender incarcerated?(Required)

Enter “N/A” if not applicable

Have you ever been removed from service at this or any other state or local facility?(Required)

Yes

If so, where?(Required)

Enter “N/A” if not applicable

Louisiana Department of Public Safety and Corrections | Sexual Assault and Sexual Misconduct with Offenders | Volunteer, Intern and Contractor Acknowledgement

Any sexual activity or relations or attempted sexual activity or relations between a volunteer, intern, or contractor and an offender are expressly forbidden. Any violation will result in disbarment from the unit and may include the filing of criminal charges as warranted.

I have read and understand the above.(Required)

Yes

Applicant Name(Required)

First Last

Applicant Electronic Signature(Required)

By typing your name, you agree to use this text input in place of a physical signature

Witness Name(Required)

First Last

Witness Electronic Signature(Required)

By typing your name, you agree to use this text input in place of a physical signature

Almost Finished

Help us reach more people! The following questions are not required, but will greatly assist Parole Project and the Frederick Douglass Project in reaching out to future participants. Please click “SUBMIT” at the bottom of this page to record your application.

How did you learn about Parole Project and Frederick Douglass Project's prison visit program? Select all that apply.

Parole Project newsletter

Frederick Douglass Project newsletter

Parole Project social media

Frederick Douglass Project social media

Web search

I participated in a previous session

Other

If someone told you about it, please select “Other” and share their name so we may thank them.

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