Reentry Application

A trauma-informed, save-and-return application. You may apply while incarcerated, with an unknown release date, and without a phone, email or permanent address. A preliminary request does not require disclosure of graphic trauma or detailed criminal history.

Step 1 of 12: Applicant

Applying for

Authorized representative (if applicable)

First name *

Last name

Preferred name

Date of birth

Email *

Used to look up your application.

Phone (optional)

State *

County

ZIP

COCAS provides reentry screening, planning, supportive services, navigation, training connections, referrals and follow-up based on eligibility, location and program availability.