ALCOHOLICS FOR CHRIST PRISON APPLICATION
Name: ________________________________________________________________________
Address: _____________________________________________________________________
_____________________________________________________________________
Phone: _________________________ Email: _______________________________
1. Do you consider yourself a born-again Christian? _________________________
2. Can you supply a letter of recommendation from your home church? _________
3. What prison will you be taking the program to? ___________________________
Address: _________________________________________________________________
4. What security requirements are needed at this prison: minimum or maximum?
__________________________________________________________________________
5. Have you contacted the chaplain of this prison? ________
Do you have his support? ________
6. Is there presently an AA or NA meeting in this prison? ___________________
7. Will you be taking our 12-step literature and workbooks to the prison
weekly? __________________________________________________________________
8. Have you ever had a felony conviction? ______ If so, what is your parole
status? __________________________________________________________________
9. If approved, when do you plan on starting A/C meetings? (Day and time)
__________________________________________________________________________
10. Will you have any assistance in leading the meetings? ____________________
__________________________________________________________________________
11. Are you willing to promote the need for prisoners to attend meetings after
their release?____________________________________________________________
12. Are you a recovering alcoholic?________ If so, please explain: ___________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________ ___________________________
Signature: Date:
Send to: A/C Prison Ministry, 1316 N. Campbell Road, Royal Oak, MI 48067