Bridging the Gap Temporary Contact Form

Bridging the Gap Temporary Contact Form
Are you being released from *
The Bridging the Gap (BTG) / Pre-Release program is a Area 48 wide service provided by Alcoholics Anonymous (AA). Coordinated by the Bridging the Gap (BTG) Committee of AA, it is a program for introducing inmates to AA in their home communities. A volunteer will connect with you, and escort you to your first couple of AA meetings upon release by phone.

As an inmate requesting an AA contact, please be aware of the following:
1. AA offers only a path to recovery from alcoholism, not money, jobs, housing or the like.
2. A contact person will get in touch with you after this form is processed. The two of you may make arrangements to meet as soon as possible alter release. This contact will help you to get to your first
  AA meetings and introduce you to AA members in your area.
3. The contact person serves as a vital link between you and the outside AA group.
4. This contact person will write to you after this form is processed, time permitting. The two of you will make arrangements for you to get to a meeting as soon as possible after your release. This contact person will help you get to your first few AA meetings, and introduce you to other AA members, in your local area.
5. We need you to supply the following information in order to get you the proper contact person.
This information will be kept confidential. You must provide a phone number so we can contact you.
The Bridging the Gap (BTG) program is a Area 48 wide service provided by Alcoholics Anonymous(AA) and coordinated by BTG Committees of AA, It is designed to help alcoholics in a treatment program make the transition to the AA program.

As a client requesting an AA contact, please be aware of the following:
1. AA offers only a path to recovery from alcoholism, not money, jobs, housing or the like.
2. A contact person will write or phone you after this form is processed. The two of you may make arrangements to meet as soon as possible. This contact will help you to get to your first AA meetings and introduce you to AA members in your area.
3. The contact person serves as a vital link between you and the outside AA group. We need you to supply the following information in order to get you the proper contact person.
This information will be kept confidential. You must provide a phone number so we can contact you.
Name *

First Name Last Name
Date

Month Day Year
Date Date Picker Icon
DIN Number
Gender Identity

Male Female Non-binary/other

Current Phone Number *

Area Code Phone Number

Email
example@example.com
Anticipated Phone Number

Area Code Phone Number
Anticipated discharge date

Month Day Year
Date Date Picker Icon
Would you like a Spanish Speaking Contact?

Yes No
County you are going to be residing in:

Albany Rensselear Greene Fulton Saratoga Delaware Schohaire Otsego Essex Clinton Dutchess Oneinda Herkimer Hamilton Lewis Washington Warren Schenectady Ulster Columbia Franklin Montgomery
Should be Empty:

Facility
Street
City	State
Zip Code	Country

Street
Street Address Line 2
City	State
Zip Code	Country