JUSTICE INVOLVED VERIFICATION

Justice-Involved Verification Form — Instructions

This form is for applicants to the San Jose ON & Beyond Free Laptop with Digital Skills & Internet Safety Course who are formerly incarcerated or currently receiving justice-related services.
The referring organization must complete this form, not the applicant alone.
Complete all requested organization information, including the organization’s name, address, authorized representative, telephone number, and email address.
Enter the applicant’s information exactly as shown on their California ID or Driver’s License.
Verify that the applicant resides in Santa Clara County, California.
Check all applicable boxes confirming the applicant’s justice-involved status, identity, residence, and income or qualifying public benefits.
The referring organization must verify all checked information through records, supporting documentation, or direct knowledge obtained while providing services.
Both the authorized organization representative and applicant must sign and date the completed form.
Email the completed form to Contact@SanJoseOn.com.
Do not text this form, as it contains personal and confidential information.
Submission of this form does not guarantee acceptance into the program.