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Day
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Name
Age
Highest Level of Education
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How many Children
Gender
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Hometown
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Drug of Choice
How long
How many treatment centers have you attended
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Name of Parole/Probation officer
If we did not accept you, where would you go?
Do you have any violent/sex crimes? (This is confidential and will go no further than here)
Tell us about your relationship with God and what is your religious background?
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Contact Us:
(662) 889-5525
crslcolumbus2021@gmail.com
P.O. Box 2831 Columbus, MS 39704
