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Personal Intake Informatiion
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Sending Authority; Are currently under the supervision of any of the following?
Marital  Status
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Military History
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Work History
Drivers Licence
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Physical and Mental Health
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Do you now or have you ever had any of the following: Please select all that apply
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Abuse History
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Legal History
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D.A.R.P FOUNDATION

Contact Us
Men's Facility
Phone 918-770-3647
Fax 479-752-3411

Women's Facility
Phone 9184539919
Fax 9184581065

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