Get Started

Start your journey with Empowerment.
Hope starts here...Welcome!

Step 1

Watch the WELCOME Orientation Intake Video

Step 2

Fill out the Pre-Intake Form
or Call 303-320-1989 , ext. 206

Step 3

An Intake Specialist will contact you in the next 24 hours, or as soon as possible

PRE-INTAKE FORM - Contact an Intake Specialist

* Indicates required field

Name *

First

Last

Gender Identity *

cisgender - your gender matches your assigned birth sex

Date of Birth *

Month/Day/Year

Phone Number *

If you do not have a phone number, please leave a number where you can be reached

OK to Leave a Message? *

Yes No

Email *

No e-mail? get one at Gmail.com today!
G-MAIL

Address *

Line 1

Line 2

City

State

Zip Code

Country

If you are homeless, please write homeless, and County

What services are you interested in? *

Mental Health Group Therapy Substance Use Group Therapy (non-DUI) Individual Therapy Employment Assistance Services for people who inject drugs Services for people involved in sex work HIV Prevention and Testing PrEP Navigation Care Management for people living with HIV Re-Entry Services

check all that apply

Who is completing this form? *

Self Healthcare Provider Probation or Parole Officer Friend/Family Member Other

If you were recently released from JAIL, when were you released? *

If you were in the RISE Unit at Denver County Jail, when were you involved in the program? *

If you were recently released from PRISON. when were you released? *

Are you on Parole? *

Yes No

Are you on Probation? *

Yes No

Comment *

Referring Agency Release of Information *

Max file size: 20MB

Submit

OUR MISSION: Holistically helping individuals build healthier lives from the inside out.

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Volunteer

The Empowerment Program
1600 York Street
Denver, CO 80206
303-320-1989
FAX: 303-320-3987

Referral

Start your journey with Empowerment.Hope starts here...Welcome!

Step 1

Watch the WELCOME Orientation Intake Video

Step 2

Fill out the Pre-Intake Form or Call 303-320-1989 , ext. 206

Step 3

An Intake Specialist will contact you in the next 24 hours, or as soon as possible

PRE-INTAKE FORM - Contact an Intake Specialist

Start your journey with Empowerment.
Hope starts here...Welcome!

Fill out the Pre-Intake Form
or Call 303-320-1989 , ext. 206