Client intake · 10 profile details and 10 meaningful questions

Inmate Profile Questionnaire

Answer what you can. Optional questions may be left blank. Cellmate Connections reviews every submission before publication. We use selected answers to prepare a shorter profile.

Submissions are limited to 20 per network every 10 minutes and 50 per day.

Privacy: Your legal name, institution, ID number, mailing instructions, provider ID, and other fields marked PRIVATE are for administrator review. They are not shown on public profiles automatically. Never enter a password, payment details, home address, medical records, victim information, or witness identifying information.

Profile information1. Display name or nickname2. Age3. Gender4. State currently incarcerated in5. Facility name (optional; choose a visibility preference below) PRIVATE6. Expected release year or date (optional) PRIVATE7. Height8. Languages spoken9. Hometown or general area10. Is a profile photo available?

10 meaningful questions11. How would you introduce yourself to someone new?12. What interests, hobbies, music, books, or activities do you enjoy?13. What kind of connection are you hoping to find?14. What qualities do you value in a friend or partner?15. What would you like a potential connection to understand about your life story? (optional)16. What goals or positive changes are you working toward?17. What communication style works best for you, within facility rules?18. What would you enjoy talking about together?19. What boundaries or expectations are important to you?20. What is one question you would like a new friend to ask you?

Consent and profile authorizationI understand that information I designate as public may appear on the Cellmate Connections website.I authorize Cellmate Connections to create and publish a profile using the information I have provided, after review.I understand I should not provide passwords, Social Security numbers, financial-account information, medical records, victim information, home addresses, or other highly sensitive information.I understand communications and contact methods are subject to correctional-facility rules.I confirm the person being profiled is at least 18 years old.I understand I may request that the profile be corrected, updated, hidden, or removed, subject to the site's procedures.

Private signature and identity verification

These details are for administrator review only and are not displayed on the public profile.

Legal name of person profiled PRIVATEFacility and inmate/DOC ID number PRIVATEPreferred approved contact provider PRIVATEFacility mailing instructions or approved mailing details PRIVATEFacility visibility preference PRIVATERelease-date visibility preference PRIVATEPrinted name of person completing the form PRIVATETyped signature PRIVATEDate signed PRIVATE

Submitting does not automatically publish your profile. An administrator reviews consent and the information before deciding what appears.