Gang Affiliation Interview Form

Full Name

First NameLast Name

Date of Birth

Date

Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Current Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Highest Level of Education Completed

Employment Status

Have you ever been associated with any groups or organizations that could be considered gangs?

If yes, please provide the name(s) of the group(s) and your role or involvement.

Have you ever displayed or worn any symbols, clothing, or tattoos commonly associated with gangs?

Please indicate which of the following behaviors you have observed or participated in (select all that apply):

Please rate your level of association with known gang members.

Known Associates (List names or nicknames, if applicable)

Have you ever been involved in any incidents or activities related to gangs?

If yes, please provide details about the incident(s) or activities.

Is there anything else you would like to share regarding your background or affiliations?