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I am

☐ The inmate ☐ A loved one or friend

My full name

Phone (optional)

Email: required for loved ones so we can confirm payment (inmates can skip)

First name *

Last name *

Inmate ID / DOC number *

Facility name *

State *

Age *

Date of birth (mm/dd/yyyy) *

Facility mailing address (exactly how mail should be addressed) *

Gender *

☐ Man ☐ Woman

Release date or year

Release date is

☐ Known ☐ Estimated ☐ Life sentence

Headline: one short line about the inmate (optional)

Can pen pals message the inmate electronically?

☐ Yes ☐ No, regular mail only

If yes, tick every app or service they use

☐ MyViaPath (formerly GTL Getting Out) ☐ JPay ☐ Securus Messaging ☐ CorrLinks (federal prisons) ☐ Access Corrections ☐ Other: __________

Hair color

☐ Black ☐ Brown ☐ Blonde ☐ Red ☐ Gray ☐ Bald ☐ Other

Eye color

☐ Brown ☐ Blue ☐ Green ☐ Hazel ☐ Gray ☐ Other

Ethnicity

☐ White ☐ Black / African American ☐ Hispanic / Latino ☐ Asian ☐ Native American ☐ Pacific Islander ☐ Multiracial ☐ Other ☐ Prefer not to say

Zodiac sign

☐ Aries ☐ Taurus ☐ Gemini ☐ Cancer ☐ Leo ☐ Virgo ☐ Libra ☐ Scorpio ☐ Sagittarius ☐ Capricorn ☐ Aquarius ☐ Pisces

Religion

☐ Christian ☐ Muslim ☐ Jewish ☐ Buddhist ☐ Hindu ☐ Spiritual ☐ Agnostic ☐ Atheist ☐ Other ☐ Prefer not to say

Education

☐ High School ☐ Some College ☐ Associate's Degree ☐ Bachelor's Degree ☐ Graduate Degree ☐ Other

Relationship status

☐ Single ☐ Married ☐ Divorced ☐ Widowed ☐ It's complicated

Wants to write to

☐ Anyone ☐ Women ☐ Men

Looking for

☐ Friendship ☐ Friendship, maybe more ☐ Romance ☐ Mentorship ☐ Pen pals from anywhere

Military

☐ Served in the military

Height

Hometown (city, state)

Interests / hobbies

Plan (pick one)

☐ 6 Months $25 ☐ 12 Months $49.90